| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,995 |
1,977 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,026 |
2,007 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,565 |
1,548 |
$23K |
| D9920 |
|
435 |
398 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
554 |
$14K |
| D9630 |
|
643 |
643 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,011 |
531 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
714 |
709 |
$5K |
| D0272 |
Bitewings - two radiographic images |
272 |
272 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
126 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
93 |
$2K |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$797.55 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
87 |
$0.00 |