| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
274 |
265 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
173 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
95 |
37 |
$10K |
| D1206 |
Topical application of fluoride varnish |
212 |
204 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
201 |
174 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
86 |
84 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
52 |
$2K |
| D0272 |
Bitewings - two radiographic images |
46 |
44 |
$1K |
| D0240 |
|
77 |
71 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
24 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$921.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$388.31 |