| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,951 |
1,781 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
499 |
261 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,351 |
1,215 |
$34K |
| D1206 |
Topical application of fluoride varnish |
547 |
522 |
$14K |
| D0274 |
Bitewings - four radiographic images |
466 |
410 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
402 |
320 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
109 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
43 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$598.03 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$484.80 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
30 |
$370.70 |