| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,304 |
1,249 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,548 |
2,444 |
$42K |
| D1120 |
Prophylaxis - child |
2,074 |
1,971 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
250 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
718 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
183 |
$19K |
| D9920 |
|
114 |
108 |
$8K |
| D1351 |
Sealant - per tooth |
2,042 |
570 |
$6K |
| D0330 |
Panoramic radiographic image |
89 |
88 |
$5K |
| D1330 |
|
3,284 |
3,115 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
118 |
$3K |
| D1206 |
Topical application of fluoride varnish |
3,371 |
3,222 |
$701.78 |
| D0272 |
Bitewings - two radiographic images |
743 |
704 |
$621.72 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
17 |
$542.13 |
| D0274 |
Bitewings - four radiographic images |
433 |
417 |
$500.75 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
14 |
$248.83 |
| D9995 |
|
18 |
17 |
$0.00 |