| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,125 |
3,088 |
$89K |
| D1206 |
Topical application of fluoride varnish |
3,763 |
3,721 |
$66K |
| D9920 |
|
839 |
818 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,230 |
3,189 |
$54K |
| D0272 |
Bitewings - two radiographic images |
970 |
960 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
169 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
157 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
26 |
$4K |
| D1110 |
Prophylaxis - adult |
119 |
117 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
288 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
25 |
$965.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
40 |
$726.50 |