| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,652 |
1,526 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
820 |
768 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
694 |
$24K |
| D1206 |
Topical application of fluoride varnish |
959 |
902 |
$20K |
| D0274 |
Bitewings - four radiographic images |
785 |
722 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
599 |
550 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
66 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
676 |
592 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
278 |
239 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
72 |
$5K |
| D0330 |
Panoramic radiographic image |
43 |
41 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
59 |
$854.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
59 |
27 |
$198.90 |
| D1999 |
|
20 |
18 |
$0.00 |