| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,304 |
1,184 |
$29K |
| D1120 |
Prophylaxis - child |
840 |
755 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,206 |
1,113 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
24 |
$5K |
| D1110 |
Prophylaxis - adult |
116 |
111 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
44 |
$2K |
| D0272 |
Bitewings - two radiographic images |
79 |
68 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
16 |
$723.52 |
| D1208 |
Topical application of fluoride, excluding varnish |
69 |
50 |
$650.80 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
29 |
$452.40 |