| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,383 |
6,324 |
$168K |
| D1120 |
Prophylaxis - child |
6,523 |
6,452 |
$152K |
| D1206 |
Topical application of fluoride varnish |
6,108 |
6,043 |
$116K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,412 |
1,400 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,759 |
3,716 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
435 |
250 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
109 |
40 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
367 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,374 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
514 |
489 |
$11K |
| D1999 |
|
587 |
579 |
$8K |
| D1351 |
Sealant - per tooth |
255 |
49 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,280 |
561 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
37 |
$752.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$304.33 |