| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
775 |
755 |
$21K |
| D1120 |
Prophylaxis - child |
490 |
483 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
809 |
790 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
669 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
50 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
761 |
738 |
$8K |
| D1110 |
Prophylaxis - adult |
108 |
106 |
$5K |
| D0272 |
Bitewings - two radiographic images |
235 |
228 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |
| D0274 |
Bitewings - four radiographic images |
57 |
57 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
24 |
$671.51 |
| D0602 |
|
67 |
67 |
$0.00 |
| D0601 |
|
447 |
438 |
$0.00 |
| D0603 |
|
37 |
36 |
$0.00 |
| D1999 |
|
162 |
148 |
$0.00 |