| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,507 |
2,344 |
$75K |
| D1206 |
Topical application of fluoride varnish |
1,645 |
1,604 |
$56K |
| D1120 |
Prophylaxis - child |
1,222 |
1,211 |
$41K |
| D1110 |
Prophylaxis - adult |
572 |
553 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
131 |
$24K |
| D0274 |
Bitewings - four radiographic images |
375 |
375 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
38 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
70 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
77 |
$3K |
| D0272 |
Bitewings - two radiographic images |
109 |
108 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
55 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
117 |
$2K |
| D1330 |
|
230 |
229 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |