| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,211 |
3,185 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
3,408 |
3,382 |
$9K |
| D1206 |
Topical application of fluoride varnish |
3,800 |
3,773 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,593 |
2,553 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
120 |
$4K |
| D1110 |
Prophylaxis - adult |
390 |
390 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,367 |
1,346 |
$2K |
| D0274 |
Bitewings - four radiographic images |
449 |
444 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
893 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
224 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
219 |
214 |
$624.22 |
| D0140 |
Limited oral evaluation - problem focused |
69 |
67 |
$159.54 |
| D0603 |
|
25 |
25 |
$0.00 |
| D0602 |
|
17 |
17 |
$0.00 |