| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
725 |
723 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
634 |
633 |
$27K |
| D1206 |
Topical application of fluoride varnish |
682 |
681 |
$20K |
| D1120 |
Prophylaxis - child |
623 |
623 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
159 |
159 |
$4K |
| D9920 |
|
15 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
28 |
$630.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$588.00 |