| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
471 |
467 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
488 |
484 |
$18K |
| D1206 |
Topical application of fluoride varnish |
506 |
501 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
46 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
141 |
$4K |
| D0272 |
Bitewings - two radiographic images |
173 |
167 |
$4K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$3K |
| D0603 |
|
282 |
270 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
54 |
$966.36 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$817.28 |
| D0602 |
|
94 |
92 |
$634.24 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$612.36 |
| D0601 |
|
76 |
76 |
$374.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$247.52 |