| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,119 |
1,118 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
956 |
955 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,020 |
1,018 |
$39K |
| D0272 |
Bitewings - two radiographic images |
466 |
465 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
45 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
242 |
232 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
416 |
411 |
$9K |
| D1110 |
Prophylaxis - adult |
69 |
69 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
76 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
237 |
178 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
167 |
167 |
$3K |
| D0240 |
|
87 |
54 |
$3K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$579.10 |
| D0603 |
|
17 |
17 |
$154.00 |
| D1330 |
|
77 |
76 |
$37.40 |