| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
480 |
412 |
$19K |
| D1206 |
Topical application of fluoride varnish |
479 |
411 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
326 |
277 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
146 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
137 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
315 |
200 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
32 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
284 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
20 |
$1K |
| D0272 |
Bitewings - two radiographic images |
83 |
70 |
$761.40 |
| D9310 |
|
45 |
45 |
$752.40 |
| D0274 |
Bitewings - four radiographic images |
14 |
12 |
$236.60 |
| D1999 |
|
433 |
366 |
$0.00 |