| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,632 |
1,113 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
648 |
493 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
374 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
979 |
640 |
$10K |
| D1206 |
Topical application of fluoride varnish |
367 |
296 |
$7K |
| D0272 |
Bitewings - two radiographic images |
317 |
252 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
26 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
371 |
272 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$504.21 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
29 |
$386.24 |
| D1999 |
|
43 |
39 |
$0.00 |