| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
664 |
657 |
$28K |
| D1120 |
Prophylaxis - child |
739 |
724 |
$21K |
| D1206 |
Topical application of fluoride varnish |
619 |
613 |
$15K |
| D0330 |
Panoramic radiographic image |
165 |
162 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
136 |
129 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$3K |
| D0272 |
Bitewings - two radiographic images |
205 |
202 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
16 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
88 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
32 |
32 |
$576.00 |