| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,381 |
1,318 |
$70K |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,271 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
207 |
197 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
337 |
$6K |
| D0272 |
Bitewings - two radiographic images |
271 |
258 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
53 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
100 |
$3K |
| D9248 |
|
40 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
434 |
377 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
69 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$266.50 |