| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
617 |
559 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
547 |
491 |
$10K |
| D0272 |
Bitewings - two radiographic images |
292 |
249 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
238 |
192 |
$2K |
| D1206 |
Topical application of fluoride varnish |
184 |
162 |
$2K |
| D0603 |
|
362 |
309 |
$1K |
| D1330 |
|
560 |
493 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
45 |
$356.72 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
13 |
$295.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
14 |
$159.95 |
| D0601 |
|
12 |
12 |
$121.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
15 |
$26.36 |
| D0602 |
|
29 |
18 |
$0.00 |