| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,736 |
1,702 |
$41K |
| D1120 |
Prophylaxis - child |
1,494 |
1,460 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,765 |
1,728 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
146 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,072 |
1,039 |
$15K |
| D1110 |
Prophylaxis - adult |
372 |
366 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,180 |
967 |
$12K |
| D0272 |
Bitewings - two radiographic images |
711 |
688 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
171 |
154 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
135 |
131 |
$5K |
| D0274 |
Bitewings - four radiographic images |
155 |
151 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
25 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$788.48 |