| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,128 |
3,079 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,781 |
2,740 |
$48K |
| D1206 |
Topical application of fluoride varnish |
3,054 |
3,001 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
555 |
504 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,229 |
1,206 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
52 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
261 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
336 |
327 |
$3K |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
90 |
$874.71 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$729.53 |