| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
393 |
375 |
$16K |
| D1206 |
Topical application of fluoride varnish |
384 |
367 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
234 |
223 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
174 |
163 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
48 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
137 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
217 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
276 |
$2K |
| D9310 |
|
42 |
40 |
$649.80 |
| D0272 |
Bitewings - two radiographic images |
53 |
51 |
$441.80 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$275.40 |
| D1999 |
|
265 |
229 |
$0.00 |