| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,247 |
3,227 |
$151K |
| D1120 |
Prophylaxis - child |
3,693 |
3,677 |
$131K |
| D1206 |
Topical application of fluoride varnish |
3,010 |
3,000 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,988 |
1,984 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
278 |
248 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
478 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,154 |
600 |
$4K |
| D0274 |
Bitewings - four radiographic images |
95 |
95 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$498.75 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$420.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$300.00 |