| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,938 |
2,810 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,318 |
3,068 |
$59K |
| D1120 |
Prophylaxis - child |
4,200 |
2,367 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
542 |
256 |
$7K |
| D1110 |
Prophylaxis - adult |
320 |
168 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,199 |
632 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,267 |
666 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
27 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
71 |
$3K |
| D1999 |
|
453 |
295 |
$3K |
| D0274 |
Bitewings - four radiographic images |
199 |
121 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
729 |
241 |
$836.61 |
| D1206 |
Topical application of fluoride varnish |
36 |
15 |
$280.03 |