| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
374 |
355 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
56 |
$6K |
| D1120 |
Prophylaxis - child |
331 |
306 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$4K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$3K |
| D0470 |
|
87 |
82 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
89 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
495 |
$336.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$262.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
597 |
443 |
$233.62 |
| D0274 |
Bitewings - four radiographic images |
262 |
256 |
$221.05 |
| D1330 |
|
551 |
520 |
$102.00 |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
479 |
$85.00 |
| D0191 |
|
149 |
149 |
$34.82 |
| D0272 |
Bitewings - two radiographic images |
68 |
49 |
$28.38 |