| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,636 |
3,001 |
$95K |
| D1120 |
Prophylaxis - child |
2,409 |
1,984 |
$82K |
| D1110 |
Prophylaxis - adult |
1,221 |
1,017 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,944 |
2,340 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,359 |
1,961 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,611 |
2,173 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,524 |
2,111 |
$34K |
| D0145 |
Oral evaluation for a patient under three years of age |
193 |
193 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
284 |
211 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
543 |
380 |
$13K |
| D1206 |
Topical application of fluoride varnish |
725 |
694 |
$9K |
| D0603 |
|
2,027 |
1,631 |
$6K |
| D0274 |
Bitewings - four radiographic images |
185 |
176 |
$6K |
| D2140 |
|
62 |
38 |
$4K |
| D0330 |
Panoramic radiographic image |
80 |
76 |
$4K |
| D1351 |
Sealant - per tooth |
104 |
27 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
41 |
$2K |
| D0602 |
|
611 |
528 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
15 |
$2K |
| D0601 |
|
12 |
12 |
$60.00 |
| D1999 |
|
12 |
12 |
$0.00 |