| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
333 |
236 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
264 |
187 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
273 |
196 |
$5K |
| D0272 |
Bitewings - two radiographic images |
148 |
107 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
17 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
178 |
126 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
43 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
87 |
$2K |
| D1206 |
Topical application of fluoride varnish |
52 |
42 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
20 |
$1K |