| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
270 |
$18K |
| D1120 |
Prophylaxis - child |
279 |
279 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
149 |
91 |
$10K |
| D1310 |
|
186 |
186 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
154 |
$8K |
| D1206 |
Topical application of fluoride varnish |
277 |
277 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
53 |
$5K |
| D0350 |
|
428 |
177 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
870 |
232 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$3K |
| D0603 |
|
154 |
154 |
$2K |
| D9920 |
|
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
120 |
120 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
72 |
69 |
$864.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$675.00 |
| D9430 |
|
14 |
13 |
$448.00 |