| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
699 |
623 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,324 |
570 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
691 |
629 |
$9K |
| D0274 |
Bitewings - four radiographic images |
276 |
247 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
696 |
617 |
$7K |
| D1110 |
Prophylaxis - adult |
154 |
138 |
$7K |
| D1120 |
Prophylaxis - child |
107 |
97 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
13 |
$3K |
| D0350 |
|
172 |
143 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
42 |
$3K |
| D1351 |
Sealant - per tooth |
160 |
28 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
17 |
$460.87 |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$184.24 |
| D0603 |
|
1,129 |
1,056 |
$0.00 |