| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
390 |
390 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
349 |
349 |
$11K |
| D1206 |
Topical application of fluoride varnish |
226 |
226 |
$6K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
43 |
$2K |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
106 |
106 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
49 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
21 |
$482.30 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$318.00 |
| D1330 |
|
13 |
13 |
$0.00 |