| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
713 |
707 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
522 |
515 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
799 |
792 |
$12K |
| D0272 |
Bitewings - two radiographic images |
430 |
428 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
189 |
179 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
175 |
174 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$783.30 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
27 |
$296.40 |