| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,249 |
1,846 |
$48K |
| D1120 |
Prophylaxis - child |
2,689 |
2,174 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,003 |
1,645 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
560 |
453 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
928 |
725 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
69 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
266 |
44 |
$9K |
| D0272 |
Bitewings - two radiographic images |
985 |
802 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
172 |
160 |
$5K |
| D1351 |
Sealant - per tooth |
187 |
29 |
$4K |
| D1999 |
|
406 |
292 |
$3K |
| D0330 |
Panoramic radiographic image |
114 |
100 |
$3K |
| D1110 |
Prophylaxis - adult |
83 |
81 |
$3K |
| D0274 |
Bitewings - four radiographic images |
63 |
58 |
$689.73 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
25 |
$500.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$294.07 |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
25 |
$204.18 |