| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,055 |
1,013 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,079 |
1,040 |
$17K |
| D1120 |
Prophylaxis - child |
468 |
448 |
$14K |
| D0272 |
Bitewings - two radiographic images |
515 |
498 |
$9K |
| D1110 |
Prophylaxis - adult |
212 |
206 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
621 |
596 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
573 |
464 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$461.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
43 |
$414.00 |
| D1999 |
|
115 |
114 |
$0.00 |