| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
905 |
682 |
$27K |
| D1206 |
Topical application of fluoride varnish |
451 |
403 |
$23K |
| D1120 |
Prophylaxis - child |
455 |
410 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
147 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
394 |
351 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
19 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
25 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
16 |
$1K |
| D0274 |
Bitewings - four radiographic images |
63 |
61 |
$787.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
20 |
20 |
$0.00 |