| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
461 |
428 |
$12K |
| D1120 |
Prophylaxis - child |
360 |
339 |
$11K |
| D1110 |
Prophylaxis - adult |
220 |
202 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
481 |
445 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
208 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
212 |
167 |
$2K |
| D0272 |
Bitewings - two radiographic images |
86 |
76 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
24 |
$918.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
62 |
$844.23 |