| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,227 |
1,227 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
284 |
100 |
$29K |
| D1120 |
Prophylaxis - child |
686 |
686 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,291 |
1,291 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,418 |
1,005 |
$16K |
| D1110 |
Prophylaxis - adult |
262 |
262 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,069 |
1,066 |
$13K |
| D0272 |
Bitewings - two radiographic images |
342 |
342 |
$8K |
| D0274 |
Bitewings - four radiographic images |
101 |
101 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
111 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$3K |
| D0602 |
|
1,359 |
1,359 |
$0.00 |