| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,072 |
904 |
$51K |
| D1120 |
Prophylaxis - child |
1,439 |
1,201 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,233 |
1,033 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
326 |
$8K |
| D0272 |
Bitewings - two radiographic images |
301 |
257 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
26 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
124 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
93 |
86 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$908.88 |