| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,278 |
3,152 |
$19K |
| D1120 |
Prophylaxis - child |
2,198 |
2,109 |
$18K |
| D1206 |
Topical application of fluoride varnish |
2,067 |
2,034 |
$11K |
| D1110 |
Prophylaxis - adult |
835 |
790 |
$9K |
| D0272 |
Bitewings - two radiographic images |
860 |
835 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,352 |
1,252 |
$3K |
| D0274 |
Bitewings - four radiographic images |
305 |
282 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
61 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
282 |
244 |
$854.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$174.50 |
| D0330 |
Panoramic radiographic image |
43 |
29 |
$146.22 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$93.00 |
| D1999 |
|
19 |
16 |
$0.00 |