| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,217 |
1,178 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,011 |
1,001 |
$28K |
| D1206 |
Topical application of fluoride varnish |
427 |
413 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
148 |
112 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
27 |
$2K |
| D0272 |
Bitewings - two radiographic images |
167 |
157 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
52 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
121 |
$744.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
60 |
$706.80 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$210.60 |