| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
408 |
405 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
422 |
412 |
$14K |
| D0272 |
Bitewings - two radiographic images |
172 |
171 |
$7K |
| D1206 |
Topical application of fluoride varnish |
173 |
172 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
181 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
151 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
53 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
52 |
$799.19 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$680.00 |
| D0140 |
Limited oral evaluation - problem focused |
19 |
15 |
$392.40 |