| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,428 |
1,428 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,541 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,497 |
1,497 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
328 |
181 |
$41K |
| D0272 |
Bitewings - two radiographic images |
613 |
613 |
$14K |
| D1110 |
Prophylaxis - adult |
246 |
246 |
$13K |
| D0330 |
Panoramic radiographic image |
168 |
168 |
$13K |
| D1354 |
|
288 |
143 |
$8K |
| D0274 |
Bitewings - four radiographic images |
180 |
180 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
41 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
251 |
251 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
25 |
$552.74 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
14 |
$0.00 |