| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,450 |
4,397 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
4,642 |
4,577 |
$18K |
| D1206 |
Topical application of fluoride varnish |
4,950 |
4,874 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
406 |
144 |
$10K |
| D0272 |
Bitewings - two radiographic images |
2,220 |
2,181 |
$7K |
| D1110 |
Prophylaxis - adult |
312 |
298 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
187 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
85 |
$1K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$626.33 |
| D0240 |
|
96 |
57 |
$471.45 |
| D0274 |
Bitewings - four radiographic images |
64 |
63 |
$348.07 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$156.24 |
| D1999 |
|
772 |
732 |
$0.00 |