| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,822 |
7,795 |
$436K |
| D1120 |
Prophylaxis - child |
8,847 |
8,811 |
$334K |
| D1206 |
Topical application of fluoride varnish |
7,561 |
7,525 |
$112K |
| D1310 |
|
1,904 |
1,896 |
$84K |
| D9993 |
|
1,899 |
1,892 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,687 |
1,677 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,351 |
1,348 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
153 |
153 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
258 |
247 |
$9K |
| D0603 |
|
814 |
812 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
636 |
331 |
$2K |
| D0274 |
Bitewings - four radiographic images |
79 |
79 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D0601 |
|
40 |
40 |
$525.00 |
| D1999 |
|
1,217 |
1,201 |
$150.00 |
| D1330 |
|
314 |
314 |
$0.00 |