| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,636 |
3,569 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,081 |
5,001 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
4,607 |
4,535 |
$78K |
| D1110 |
Prophylaxis - adult |
1,336 |
1,321 |
$51K |
| D9920 |
|
672 |
588 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,359 |
1,334 |
$23K |
| D0274 |
Bitewings - four radiographic images |
578 |
573 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
114 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
155 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
25 |
$438.62 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
57 |
$334.50 |
| D9630 |
|
13 |
13 |
$258.31 |