| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,814 |
1,814 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,410 |
2,410 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,087 |
2,086 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
350 |
206 |
$39K |
| D1110 |
Prophylaxis - adult |
647 |
647 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,233 |
1,223 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,017 |
983 |
$8K |
| D0272 |
Bitewings - two radiographic images |
267 |
266 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
18 |
$2K |
| D0274 |
Bitewings - four radiographic images |
53 |
53 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
244 |
235 |
$0.00 |