| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
537 |
427 |
$17K |
| D1120 |
Prophylaxis - child |
605 |
486 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
83 |
$13K |
| D1206 |
Topical application of fluoride varnish |
339 |
299 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
232 |
171 |
$6K |
| D0330 |
Panoramic radiographic image |
221 |
166 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
49 |
$5K |
| D1351 |
Sealant - per tooth |
183 |
38 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
104 |
$4K |
| D0274 |
Bitewings - four radiographic images |
169 |
149 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
89 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$303.31 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
14 |
$274.62 |
| D0272 |
Bitewings - two radiographic images |
17 |
16 |
$256.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
12 |
$187.00 |
| D1330 |
|
12 |
12 |
$0.00 |