| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,056 |
10,043 |
$523K |
| D0120 |
Periodic oral evaluation - established patient |
13,002 |
12,959 |
$379K |
| D1206 |
Topical application of fluoride varnish |
13,336 |
13,315 |
$354K |
| D1110 |
Prophylaxis - adult |
1,217 |
1,201 |
$83K |
| D0272 |
Bitewings - two radiographic images |
831 |
828 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
66 |
$10K |
| D0274 |
Bitewings - four radiographic images |
150 |
150 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
151 |
151 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
40 |
$813.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$240.00 |