| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,385 |
3,217 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,718 |
3,525 |
$85K |
| D1110 |
Prophylaxis - adult |
1,506 |
1,396 |
$78K |
| D1120 |
Prophylaxis - child |
1,200 |
1,141 |
$44K |
| D0274 |
Bitewings - four radiographic images |
658 |
637 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
133 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
36 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
25 |
$861.56 |
| D0272 |
Bitewings - two radiographic images |
32 |
26 |
$719.16 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$226.15 |