| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,745 |
1,740 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,637 |
1,635 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,549 |
1,541 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
944 |
681 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
857 |
833 |
$15K |
| D0272 |
Bitewings - two radiographic images |
566 |
559 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
89 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
14 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
115 |
115 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
37 |
$995.00 |
| D1999 |
|
89 |
85 |
$574.00 |