| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
113 |
$5K |
| D1120 |
Prophylaxis - child |
128 |
124 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
14 |
$3K |
| D1206 |
Topical application of fluoride varnish |
145 |
141 |
$2K |
| D0240 |
|
140 |
70 |
$2K |
| D0272 |
Bitewings - two radiographic images |
84 |
81 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
24 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
21 |
$988.68 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$499.59 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
13 |
$418.11 |
| D9248 |
|
15 |
13 |
$0.00 |