| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,926 |
1,687 |
$39K |
| D1110 |
Prophylaxis - adult |
970 |
870 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,604 |
1,381 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,705 |
1,475 |
$26K |
| D1120 |
Prophylaxis - child |
953 |
816 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
205 |
190 |
$6K |
| D0602 |
|
1,299 |
1,108 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
36 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
154 |
120 |
$3K |
| D1351 |
Sealant - per tooth |
76 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
35 |
$1K |
| D0330 |
Panoramic radiographic image |
47 |
47 |
$1K |
| D0601 |
|
209 |
203 |
$610.00 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
24 |
$464.04 |