| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,251 |
2,007 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
745 |
401 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,264 |
2,022 |
$55K |
| D1120 |
Prophylaxis - child |
2,226 |
2,000 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
879 |
701 |
$21K |
| D1351 |
Sealant - per tooth |
745 |
187 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
584 |
532 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
263 |
$13K |
| D1110 |
Prophylaxis - adult |
284 |
230 |
$11K |
| D0272 |
Bitewings - two radiographic images |
772 |
698 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
37 |
$4K |
| D0330 |
Panoramic radiographic image |
91 |
89 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
107 |
83 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
122 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
39 |
$927.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
26 |
$120.87 |