| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,860 |
6,720 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,036 |
1,028 |
$134K |
| D1206 |
Topical application of fluoride varnish |
7,265 |
7,081 |
$130K |
| D1120 |
Prophylaxis - child |
4,472 |
4,378 |
$102K |
| D1110 |
Prophylaxis - adult |
2,355 |
2,284 |
$91K |
| D0272 |
Bitewings - two radiographic images |
4,946 |
4,847 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
459 |
243 |
$37K |
| D0330 |
Panoramic radiographic image |
673 |
651 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
256 |
168 |
$13K |
| D1999 |
|
823 |
750 |
$11K |
| D9999 |
Unspecified adjunctive procedure, by report |
244 |
241 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
155 |
$6K |
| D1351 |
Sealant - per tooth |
48 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
81 |
77 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
82 |
$774.42 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$280.00 |