| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
762 |
755 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
730 |
724 |
$15K |
| D1206 |
Topical application of fluoride varnish |
601 |
601 |
$12K |
| D0272 |
Bitewings - two radiographic images |
474 |
473 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
319 |
313 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
33 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
69 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
29 |
$2K |
| D1110 |
Prophylaxis - adult |
23 |
23 |
$1K |
| D0274 |
Bitewings - four radiographic images |
23 |
23 |
$876.90 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
31 |
$241.94 |