| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
557 |
530 |
$11K |
| D1206 |
Topical application of fluoride varnish |
412 |
401 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
298 |
284 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
144 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
66 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
73 |
69 |
$851.96 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$404.50 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$128.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$70.44 |