| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
379 |
360 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
589 |
564 |
$15K |
| D1206 |
Topical application of fluoride varnish |
514 |
490 |
$11K |
| D1110 |
Prophylaxis - adult |
188 |
183 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
94 |
84 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
53 |
52 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
46 |
45 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
25 |
$924.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
27 |
$416.91 |