| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,263 |
1,205 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,670 |
1,602 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
837 |
796 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
834 |
773 |
$19K |
| D1110 |
Prophylaxis - adult |
350 |
343 |
$15K |
| D0274 |
Bitewings - four radiographic images |
790 |
742 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,289 |
1,189 |
$7K |
| D1206 |
Topical application of fluoride varnish |
154 |
154 |
$4K |
| D0330 |
Panoramic radiographic image |
186 |
179 |
$4K |
| D4341 |
|
25 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
642 |
575 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
121 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
114 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$473.20 |
| D0272 |
Bitewings - two radiographic images |
47 |
43 |
$448.35 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
13 |
$338.00 |