| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,646 |
1,556 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
2,094 |
1,984 |
$25K |
| D1206 |
Topical application of fluoride varnish |
2,161 |
2,040 |
$19K |
| D0274 |
Bitewings - four radiographic images |
926 |
858 |
$13K |
| D0272 |
Bitewings - two radiographic images |
533 |
522 |
$5K |
| D1110 |
Prophylaxis - adult |
455 |
424 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
520 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$414.10 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
13 |
$285.91 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
239 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
98 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
37 |
$0.00 |
| D1999 |
|
15 |
15 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
70 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
15 |
$0.00 |