| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
251 |
244 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$6K |
| D1206 |
Topical application of fluoride varnish |
275 |
265 |
$5K |
| D0272 |
Bitewings - two radiographic images |
260 |
250 |
$5K |
| D1110 |
Prophylaxis - adult |
106 |
102 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
285 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
42 |
$4K |
| D0240 |
|
194 |
184 |
$4K |
| D1120 |
Prophylaxis - child |
85 |
80 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
100 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
95 |
$3K |
| D2140 |
|
40 |
19 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
42 |
$2K |
| D0603 |
|
270 |
264 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
41 |
$527.25 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$524.40 |