| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
313 |
$12K |
| D1120 |
Prophylaxis - child |
467 |
447 |
$12K |
| D1206 |
Topical application of fluoride varnish |
435 |
414 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
26 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
174 |
170 |
$4K |
| D0272 |
Bitewings - two radiographic images |
201 |
191 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
86 |
78 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
50 |
43 |
$167.54 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
12 |
$151.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$136.08 |