| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,456 |
2,915 |
$82K |
| D1120 |
Prophylaxis - child |
1,976 |
1,702 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,143 |
1,820 |
$43K |
| D1110 |
Prophylaxis - adult |
867 |
739 |
$41K |
| D0274 |
Bitewings - four radiographic images |
646 |
588 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
153 |
$20K |
| D0330 |
Panoramic radiographic image |
278 |
261 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
75 |
$13K |
| D1206 |
Topical application of fluoride varnish |
490 |
463 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
57 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
120 |
$6K |
| D0272 |
Bitewings - two radiographic images |
244 |
200 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
44 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
38 |
$525.62 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
13 |
$462.00 |
| D1999 |
|
156 |
91 |
$0.00 |