| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,932 |
1,808 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,112 |
1,983 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,275 |
2,157 |
$41K |
| D1110 |
Prophylaxis - adult |
1,058 |
1,009 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,060 |
898 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
136 |
$18K |
| D2394 |
|
177 |
84 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
756 |
698 |
$16K |
| D0272 |
Bitewings - two radiographic images |
895 |
828 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
118 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
887 |
861 |
$12K |
| D0274 |
Bitewings - four radiographic images |
249 |
232 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
101 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$348.00 |
| D1999 |
|
16 |
15 |
$0.00 |