| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,499 |
4,315 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
4,033 |
3,870 |
$128K |
| D1206 |
Topical application of fluoride varnish |
3,973 |
3,813 |
$104K |
| D0274 |
Bitewings - four radiographic images |
401 |
377 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
103 |
$14K |
| D0272 |
Bitewings - two radiographic images |
294 |
281 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
302 |
287 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
64 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
136 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
12 |
$764.40 |