| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
698 |
677 |
$35K |
| D1206 |
Topical application of fluoride varnish |
753 |
723 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
495 |
482 |
$14K |
| D0274 |
Bitewings - four radiographic images |
178 |
171 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
24 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
72 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
151 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
124 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$539.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
27 |
$435.00 |