| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,749 |
1,651 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,011 |
1,927 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,528 |
1,432 |
$39K |
| D0272 |
Bitewings - two radiographic images |
372 |
367 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
44 |
$7K |
| D1110 |
Prophylaxis - adult |
55 |
55 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
53 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
131 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
58 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$686.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$644.00 |
| D1999 |
|
426 |
392 |
$0.00 |