| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,379 |
7,169 |
$186K |
| D1110 |
Prophylaxis - adult |
4,445 |
4,299 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,407 |
934 |
$146K |
| D1206 |
Topical application of fluoride varnish |
5,621 |
5,465 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,606 |
2,512 |
$80K |
| D1120 |
Prophylaxis - child |
2,410 |
2,359 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,189 |
3,964 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,441 |
2,797 |
$53K |
| D0330 |
Panoramic radiographic image |
757 |
726 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
760 |
716 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
155 |
$16K |
| D0272 |
Bitewings - two radiographic images |
532 |
525 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
121 |
116 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
16 |
$844.86 |
| D4346 |
|
16 |
13 |
$481.79 |
| D1999 |
|
79 |
71 |
$0.00 |