| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
251 |
247 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
298 |
298 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
342 |
342 |
$5K |
| D0272 |
Bitewings - two radiographic images |
235 |
230 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
262 |
256 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
68 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
212 |
205 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
85 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
16 |
$2K |
| D1206 |
Topical application of fluoride varnish |
33 |
29 |
$754.00 |