| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
544 |
513 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
318 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
281 |
$10K |
| D0274 |
Bitewings - four radiographic images |
179 |
178 |
$5K |
| D1206 |
Topical application of fluoride varnish |
233 |
223 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
21 |
$4K |
| D0330 |
Panoramic radiographic image |
81 |
78 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
118 |
80 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
108 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
45 |
39 |
$884.12 |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
73 |
$859.66 |