| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,083 |
1,060 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,311 |
1,277 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,053 |
1,031 |
$22K |
| D1110 |
Prophylaxis - adult |
163 |
160 |
$7K |
| D0272 |
Bitewings - two radiographic images |
294 |
292 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
157 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
133 |
129 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
25 |
$3K |
| D0240 |
|
155 |
82 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
75 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$976.50 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$132.50 |