| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,182 |
1,161 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
844 |
826 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,041 |
1,020 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
182 |
$6K |
| D0272 |
Bitewings - two radiographic images |
294 |
293 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
394 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
117 |
$4K |
| D0603 |
|
621 |
608 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
445 |
191 |
$4K |
| D0602 |
|
491 |
487 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
30 |
$3K |
| D1999 |
|
15 |
15 |
$0.00 |
| D1330 |
|
25 |
25 |
$0.00 |