| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,006 |
1,003 |
$29K |
| D1120 |
Prophylaxis - child |
701 |
697 |
$26K |
| D1206 |
Topical application of fluoride varnish |
864 |
862 |
$20K |
| D0272 |
Bitewings - two radiographic images |
421 |
418 |
$12K |
| D1110 |
Prophylaxis - adult |
201 |
200 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
259 |
246 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
45 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
112 |
110 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
26 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
68 |
$950.66 |