| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
635 |
612 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
329 |
$4K |
| D1206 |
Topical application of fluoride varnish |
626 |
597 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
809 |
754 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
802 |
654 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
46 |
$2K |
| D0272 |
Bitewings - two radiographic images |
327 |
308 |
$2K |
| D1351 |
Sealant - per tooth |
137 |
37 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
120 |
$756.03 |
| D0120 |
Periodic oral evaluation - established patient |
72 |
72 |
$698.61 |
| D0274 |
Bitewings - four radiographic images |
39 |
35 |
$416.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
70 |
69 |
$339.00 |
| D0330 |
Panoramic radiographic image |
31 |
28 |
$278.71 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$191.28 |
| D1110 |
Prophylaxis - adult |
17 |
15 |
$176.12 |
| D0603 |
|
140 |
127 |
$0.00 |