| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,653 |
3,612 |
$51K |
| D1110 |
Prophylaxis - adult |
1,324 |
1,301 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,800 |
2,770 |
$37K |
| D1120 |
Prophylaxis - child |
1,547 |
1,528 |
$29K |
| D9630 |
|
737 |
728 |
$14K |
| D0274 |
Bitewings - four radiographic images |
464 |
459 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
462 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
103 |
$5K |
| D0272 |
Bitewings - two radiographic images |
235 |
235 |
$634.80 |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
88 |
$0.00 |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
71 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
163 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$0.00 |
| D1351 |
Sealant - per tooth |
305 |
96 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
83 |
83 |
$0.00 |