| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,359 |
1,311 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
275 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,368 |
926 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,048 |
1,041 |
$7K |
| D1120 |
Prophylaxis - child |
771 |
769 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,013 |
1,010 |
$6K |
| D1110 |
Prophylaxis - adult |
361 |
360 |
$2K |
| D0272 |
Bitewings - two radiographic images |
371 |
371 |
$369.40 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
170 |
$0.00 |
| D0270 |
|
24 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
351 |
351 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
42 |
$0.00 |
| D0330 |
Panoramic radiographic image |
218 |
218 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
255 |
255 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
226 |
$0.00 |
| D1351 |
Sealant - per tooth |
113 |
46 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
27 |
$0.00 |