| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
806 |
801 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,577 |
812 |
$16K |
| D0274 |
Bitewings - four radiographic images |
605 |
602 |
$16K |
| D1120 |
Prophylaxis - child |
313 |
313 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
882 |
876 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
45 |
$9K |
| D1110 |
Prophylaxis - adult |
181 |
177 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
439 |
438 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
138 |
30 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
85 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$847.68 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$339.24 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$280.56 |
| D0603 |
|
945 |
935 |
$126.18 |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
71 |
57 |
$35.90 |
| D1330 |
|
17 |
17 |
$24.75 |
| 98971 |
|
68 |
56 |
$0.00 |
| D0601 |
|
25 |
25 |
$0.00 |
| 98970 |
|
64 |
54 |
$0.00 |
| 99072 |
|
65 |
56 |
$0.00 |