| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,691 |
7,673 |
$437K |
| D1120 |
Prophylaxis - child |
8,000 |
7,977 |
$313K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,556 |
8,529 |
$103K |
| D9920 |
|
705 |
701 |
$87K |
| D1110 |
Prophylaxis - adult |
740 |
736 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
246 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,169 |
3,028 |
$25K |
| D1310 |
|
332 |
332 |
$15K |
| D0272 |
Bitewings - two radiographic images |
961 |
961 |
$11K |
| D0274 |
Bitewings - four radiographic images |
416 |
415 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
148 |
131 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
62 |
$4K |
| D0601 |
|
236 |
236 |
$3K |
| D1351 |
Sealant - per tooth |
52 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$528.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$144.00 |
| D1999 |
|
95 |
95 |
$0.00 |