| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
647 |
575 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
567 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
664 |
599 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
71 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
220 |
182 |
$6K |
| D0272 |
Bitewings - two radiographic images |
262 |
225 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
206 |
179 |
$2K |
| D1110 |
Prophylaxis - adult |
21 |
13 |
$573.54 |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$495.00 |