| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
745 |
672 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
483 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
594 |
537 |
$9K |
| D0330 |
Panoramic radiographic image |
157 |
147 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
153 |
139 |
$4K |
| D0272 |
Bitewings - two radiographic images |
131 |
124 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
31 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
42 |
$78.32 |
| D1999 |
|
150 |
127 |
$0.00 |