| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
974 |
816 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
642 |
516 |
$20K |
| D1206 |
Topical application of fluoride varnish |
704 |
597 |
$14K |
| D0274 |
Bitewings - four radiographic images |
190 |
172 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
167 |
155 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
72 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$631.20 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$368.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$195.80 |