| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,848 |
1,425 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,283 |
958 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
656 |
524 |
$21K |
| D1206 |
Topical application of fluoride varnish |
846 |
658 |
$15K |
| D0330 |
Panoramic radiographic image |
271 |
191 |
$10K |
| D0274 |
Bitewings - four radiographic images |
325 |
222 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
40 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
281 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
142 |
112 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
213 |
161 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
100 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
12 |
$300.96 |