| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
579 |
575 |
$16K |
| D1110 |
Prophylaxis - adult |
262 |
262 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
962 |
960 |
$14K |
| D1120 |
Prophylaxis - child |
354 |
354 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
445 |
339 |
$12K |
| D0272 |
Bitewings - two radiographic images |
515 |
512 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
646 |
639 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
609 |
532 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
151 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
54 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
14 |
$3K |
| D0603 |
|
169 |
168 |
$0.00 |
| D0602 |
|
363 |
362 |
$0.00 |
| D0601 |
|
18 |
17 |
$0.00 |