| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,306 |
2,306 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,240 |
2,240 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,340 |
2,339 |
$42K |
| D0272 |
Bitewings - two radiographic images |
972 |
972 |
$17K |
| D0601 |
|
345 |
345 |
$4K |
| D0603 |
|
335 |
334 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
109 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$2K |
| D1330 |
|
188 |
188 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
99 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$991.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$563.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$448.00 |
| D0240 |
|
23 |
13 |
$255.33 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
14 |
$205.00 |
| D1999 |
|
31 |
29 |
$203.00 |