| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,217 |
1,154 |
$21K |
| D1999 |
|
1,208 |
925 |
$20K |
| D1110 |
Prophylaxis - adult |
597 |
570 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,423 |
1,349 |
$19K |
| D1120 |
Prophylaxis - child |
308 |
292 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
365 |
276 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
17 |
$3K |
| D0274 |
Bitewings - four radiographic images |
134 |
133 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
65 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
55 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
58 |
$646.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$316.80 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$252.00 |