| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
264 |
220 |
$19K |
| D1206 |
Topical application of fluoride varnish |
171 |
168 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
83 |
$4K |
| D1120 |
Prophylaxis - child |
74 |
72 |
$479.48 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
16 |
$429.92 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
16 |
$107.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$78.00 |
| D0120 |
Periodic oral evaluation - established patient |
55 |
54 |
$48.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
16 |
$33.60 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |