| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
181 |
177 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
403 |
394 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
190 |
189 |
$5K |
| D0274 |
Bitewings - four radiographic images |
235 |
229 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
673 |
361 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
482 |
464 |
$4K |
| D1110 |
Prophylaxis - adult |
66 |
65 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
14 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
75 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
20 |
$570.01 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$482.34 |
| D0601 |
|
560 |
536 |
$0.00 |
| D0603 |
|
28 |
28 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |