| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
297 |
$13K |
| D1120 |
Prophylaxis - child |
355 |
348 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
235 |
207 |
$8K |
| D1206 |
Topical application of fluoride varnish |
232 |
232 |
$6K |
| D0274 |
Bitewings - four radiographic images |
145 |
145 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
108 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
41 |
39 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
36 |
$601.57 |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
33 |
$390.32 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$283.58 |