| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,147 |
1,147 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,483 |
2,483 |
$53K |
| D1120 |
Prophylaxis - child |
1,447 |
1,447 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,250 |
2,250 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
530 |
$16K |
| D9248 |
|
255 |
254 |
$15K |
| D0274 |
Bitewings - four radiographic images |
311 |
311 |
$8K |
| D0272 |
Bitewings - two radiographic images |
421 |
421 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
181 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
361 |
361 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D9920 |
|
84 |
81 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
14 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$449.05 |