| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,016 |
3,016 |
$87K |
| D1120 |
Prophylaxis - child |
2,649 |
2,649 |
$79K |
| D0272 |
Bitewings - two radiographic images |
1,746 |
1,746 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,504 |
2,499 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,614 |
2,614 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,431 |
2,409 |
$22K |
| D1206 |
Topical application of fluoride varnish |
320 |
320 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
95 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$2K |
| D0274 |
Bitewings - four radiographic images |
61 |
61 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
14 |
$1K |