| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
214 |
205 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
93 |
87 |
$6K |
| D1206 |
Topical application of fluoride varnish |
212 |
203 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
136 |
127 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
264 |
165 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
173 |
$1K |
| D0272 |
Bitewings - two radiographic images |
87 |
82 |
$865.02 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$856.80 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$814.50 |
| D9920 |
|
16 |
15 |
$775.00 |
| D9310 |
|
40 |
37 |
$615.60 |