| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,778 |
1,715 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
174 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
243 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
161 |
$8K |
| D1120 |
Prophylaxis - child |
1,891 |
1,828 |
$5K |
| D1351 |
Sealant - per tooth |
996 |
277 |
$3K |
| D1110 |
Prophylaxis - adult |
93 |
90 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
562 |
498 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
117 |
$576.77 |
| D1206 |
Topical application of fluoride varnish |
1,806 |
1,738 |
$244.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,147 |
683 |
$162.27 |
| D0240 |
|
1,261 |
1,195 |
$121.12 |
| D0220 |
Intraoral - periapical first radiographic image |
847 |
817 |
$52.69 |
| D0274 |
Bitewings - four radiographic images |
218 |
215 |
$34.61 |
| D1330 |
|
2,052 |
1,982 |
$17.84 |
| D0272 |
Bitewings - two radiographic images |
999 |
961 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
235 |
235 |
$0.00 |