| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
285 |
273 |
$7K |
| D1120 |
Prophylaxis - child |
384 |
373 |
$3K |
| D1206 |
Topical application of fluoride varnish |
277 |
270 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
105 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D1330 |
|
438 |
426 |
$959.79 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
38 |
$855.63 |
| D0272 |
Bitewings - two radiographic images |
190 |
182 |
$809.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
97 |
$504.25 |
| D9986 |
|
15 |
13 |
$0.00 |