| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,933 |
1,919 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,173 |
1,165 |
$77K |
| D1310 |
|
1,169 |
1,162 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,908 |
1,894 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
185 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
294 |
$20K |
| D0603 |
|
1,114 |
1,107 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
394 |
331 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,534 |
1,311 |
$15K |
| D0272 |
Bitewings - two radiographic images |
988 |
982 |
$12K |
| D9993 |
|
122 |
122 |
$7K |
| D0350 |
|
629 |
305 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
67 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |