| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
423 |
409 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
697 |
195 |
$8K |
| D1206 |
Topical application of fluoride varnish |
564 |
531 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
205 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
215 |
200 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
31 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
306 |
294 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
72 |
69 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
27 |
$1K |
| D0330 |
Panoramic radiographic image |
37 |
35 |
$905.97 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
15 |
$515.09 |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$415.32 |
| D9310 |
|
12 |
12 |
$160.38 |
| D0603 |
|
735 |
715 |
$0.00 |