| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,981 |
3,840 |
$96K |
| D1110 |
Prophylaxis - adult |
1,832 |
1,745 |
$85K |
| D1206 |
Topical application of fluoride varnish |
3,729 |
3,606 |
$72K |
| D1120 |
Prophylaxis - child |
1,745 |
1,709 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
4,195 |
4,047 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,513 |
3,392 |
$45K |
| D0274 |
Bitewings - four radiographic images |
558 |
530 |
$17K |
| D0272 |
Bitewings - two radiographic images |
528 |
516 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
39 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$436.92 |