| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
320 |
317 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
357 |
352 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
369 |
326 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
459 |
452 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
38 |
$5K |
| D0272 |
Bitewings - two radiographic images |
119 |
117 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$459.16 |
| D0603 |
|
703 |
688 |
$0.00 |