| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
775 |
753 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
412 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
793 |
765 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
47 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
27 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
278 |
273 |
$8K |
| D0274 |
Bitewings - four radiographic images |
146 |
145 |
$5K |
| D9248 |
|
76 |
56 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
71 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$3K |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$1K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$624.13 |