| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
372 |
372 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
860 |
859 |
$27K |
| D1120 |
Prophylaxis - child |
776 |
774 |
$22K |
| D1206 |
Topical application of fluoride varnish |
507 |
506 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
124 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
434 |
$8K |
| D0272 |
Bitewings - two radiographic images |
418 |
417 |
$8K |
| D1110 |
Prophylaxis - adult |
169 |
169 |
$7K |
| D1351 |
Sealant - per tooth |
168 |
44 |
$5K |
| D0603 |
|
349 |
349 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
32 |
$3K |
| D1330 |
|
363 |
363 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
68 |
$619.60 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$599.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
24 |
$542.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$435.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
36 |
$361.60 |