| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,108 |
$8K |
| D1206 |
Topical application of fluoride varnish |
384 |
384 |
$7K |
| D1120 |
Prophylaxis - child |
2,733 |
2,702 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
25 |
16 |
$6K |
| D1110 |
Prophylaxis - adult |
758 |
747 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,557 |
1,534 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,084 |
1,070 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
88 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
350 |
$873.94 |
| D0330 |
Panoramic radiographic image |
660 |
652 |
$804.54 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
270 |
249 |
$592.55 |
| D0220 |
Intraoral - periapical first radiographic image |
3,088 |
3,023 |
$276.96 |
| D0603 |
|
283 |
283 |
$0.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,961 |
2,922 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,898 |
2,880 |
$0.00 |
| D9920 |
|
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
197 |
$0.00 |
| D1351 |
Sealant - per tooth |
96 |
29 |
$0.00 |
| D3120 |
|
106 |
43 |
$0.00 |