| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,072 |
2,387 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,473 |
1,325 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,396 |
928 |
$33K |
| D0330 |
Panoramic radiographic image |
519 |
337 |
$11K |
| D0272 |
Bitewings - two radiographic images |
724 |
560 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
575 |
465 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
39 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
339 |
313 |
$5K |
| D1206 |
Topical application of fluoride varnish |
393 |
231 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
230 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
52 |
50 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$316.05 |
| D1999 |
|
657 |
582 |
$0.00 |