| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,435 |
2,409 |
$55K |
| D1120 |
Prophylaxis - child |
1,879 |
1,859 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,577 |
2,542 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
254 |
$28K |
| D1110 |
Prophylaxis - adult |
460 |
455 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
627 |
552 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
301 |
299 |
$8K |
| D1999 |
|
539 |
503 |
$7K |
| D0272 |
Bitewings - two radiographic images |
623 |
617 |
$6K |
| D0274 |
Bitewings - four radiographic images |
263 |
252 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
43 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$510.60 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$290.08 |