| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
425 |
397 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
415 |
383 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
290 |
277 |
$2K |
| D0272 |
Bitewings - two radiographic images |
106 |
81 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
55 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$0.00 |