| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
328 |
327 |
$8K |
| D1120 |
Prophylaxis - child |
253 |
252 |
$6K |
| D1206 |
Topical application of fluoride varnish |
335 |
334 |
$5K |
| D1110 |
Prophylaxis - adult |
65 |
65 |
$2K |
| D0272 |
Bitewings - two radiographic images |
180 |
179 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
60 |
59 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
111 |
$876.16 |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$592.31 |
| D0240 |
|
63 |
32 |
$561.33 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$280.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
71 |
$221.79 |