| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,388 |
3,336 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,960 |
3,899 |
$117K |
| D1206 |
Topical application of fluoride varnish |
4,449 |
4,383 |
$110K |
| D1330 |
|
2,106 |
2,077 |
$13K |
| D1110 |
Prophylaxis - adult |
202 |
202 |
$12K |
| D0272 |
Bitewings - two radiographic images |
729 |
715 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
156 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
37 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
161 |
149 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$561.60 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$264.00 |