| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
565 |
497 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
61 |
$13K |
| D1206 |
Topical application of fluoride varnish |
433 |
400 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
27 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
211 |
201 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
81 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
214 |
178 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
69 |
$1K |
| D0274 |
Bitewings - four radiographic images |
51 |
46 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
12 |
$50.40 |