| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,707 |
2,690 |
$147K |
| D1120 |
Prophylaxis - child |
3,215 |
3,190 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,850 |
2,835 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,106 |
1,547 |
$12K |
| D0272 |
Bitewings - two radiographic images |
869 |
862 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
117 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
197 |
185 |
$6K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$3K |
| D1310 |
|
76 |
76 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
24 |
$3K |
| D0603 |
|
29 |
29 |
$427.50 |
| D9920 |
|
14 |
14 |
$280.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$199.50 |
| D0350 |
|
46 |
26 |
$12.00 |