| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
351 |
329 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
613 |
582 |
$8K |
| D1110 |
Prophylaxis - adult |
171 |
160 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
568 |
277 |
$5K |
| D1120 |
Prophylaxis - child |
116 |
112 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
15 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
283 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
58 |
$2K |
| D0274 |
Bitewings - four radiographic images |
53 |
50 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$514.56 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
16 |
$460.87 |
| D0603 |
|
1,047 |
884 |
$249.01 |
| D1330 |
|
22 |
18 |
$24.75 |
| D0601 |
|
14 |
13 |
$0.00 |