| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
589 |
587 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
651 |
647 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
515 |
512 |
$11K |
| D0274 |
Bitewings - four radiographic images |
199 |
195 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
102 |
$6K |
| D1206 |
Topical application of fluoride varnish |
164 |
160 |
$4K |
| D1110 |
Prophylaxis - adult |
69 |
68 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
106 |
104 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
100 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$715.00 |
| D0240 |
|
52 |
25 |
$540.00 |