| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
645 |
590 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
936 |
833 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
731 |
623 |
$17K |
| D0272 |
Bitewings - two radiographic images |
370 |
351 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
305 |
262 |
$8K |
| D1206 |
Topical application of fluoride varnish |
346 |
320 |
$7K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
17 |
$874.48 |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
48 |
$711.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
35 |
$452.40 |