| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,162 |
2,017 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,492 |
2,331 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,088 |
1,023 |
$25K |
| D1110 |
Prophylaxis - adult |
369 |
344 |
$13K |
| D0272 |
Bitewings - two radiographic images |
682 |
607 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
691 |
622 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
220 |
$6K |
| D0330 |
Panoramic radiographic image |
116 |
110 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
24 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
40 |
$805.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$455.80 |
| D0140 |
Limited oral evaluation - problem focused |
19 |
12 |
$288.00 |
| D1999 |
|
20 |
20 |
$0.00 |