| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,335 |
7,167 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
7,137 |
6,972 |
$225K |
| D1206 |
Topical application of fluoride varnish |
7,766 |
7,586 |
$203K |
| D0272 |
Bitewings - two radiographic images |
1,132 |
1,105 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
78 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
26 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$517.44 |