| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,730 |
1,183 |
$7K |
| D1120 |
Prophylaxis - child |
3,383 |
1,076 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
818 |
308 |
$1K |
| D0272 |
Bitewings - two radiographic images |
1,133 |
344 |
$832.00 |
| D1206 |
Topical application of fluoride varnish |
2,434 |
703 |
$715.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,480 |
433 |
$165.00 |
| D0330 |
Panoramic radiographic image |
197 |
40 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
37 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
38 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
60 |
60 |
$0.00 |