| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,128 |
3,113 |
$349K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
510 |
$61K |
| D1120 |
Prophylaxis - child |
3,395 |
3,372 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
231 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,157 |
3,106 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,827 |
1,818 |
$18K |
| D1206 |
Topical application of fluoride varnish |
3,085 |
3,069 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,663 |
2,913 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
126 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
517 |
273 |
$9K |
| D0274 |
Bitewings - four radiographic images |
294 |
292 |
$5K |
| D0330 |
Panoramic radiographic image |
69 |
69 |
$3K |
| D2140 |
|
222 |
107 |
$2K |
| D1351 |
Sealant - per tooth |
40 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
27 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
63 |
$0.00 |