| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,468 |
3,438 |
$91K |
| D1120 |
Prophylaxis - child |
2,766 |
2,733 |
$76K |
| D1110 |
Prophylaxis - adult |
1,277 |
1,267 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,621 |
2,583 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,713 |
2,280 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,631 |
2,575 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
192 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,100 |
1,072 |
$19K |
| D0274 |
Bitewings - four radiographic images |
559 |
557 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
209 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
531 |
529 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
39 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
136 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
147 |
$6K |
| D1351 |
Sealant - per tooth |
133 |
54 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$2K |
| D1999 |
|
840 |
811 |
$0.00 |