| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,303 |
1,267 |
$36K |
| D1351 |
Sealant - per tooth |
1,322 |
247 |
$35K |
| D1120 |
Prophylaxis - child |
880 |
855 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
113 |
$23K |
| D1110 |
Prophylaxis - adult |
443 |
431 |
$23K |
| D0274 |
Bitewings - four radiographic images |
611 |
591 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,280 |
1,248 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,590 |
1,216 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,359 |
1,311 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
91 |
$6K |
| D0272 |
Bitewings - two radiographic images |
267 |
260 |
$6K |
| D1206 |
Topical application of fluoride varnish |
257 |
249 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
75 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
50 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$206.58 |
| D0601 |
|
49 |
49 |
$0.00 |
| D0603 |
|
415 |
406 |
$0.00 |
| D0602 |
|
943 |
933 |
$0.00 |