| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,685 |
1,674 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
976 |
966 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,678 |
1,666 |
$26K |
| D1310 |
|
602 |
599 |
$26K |
| D9993 |
|
311 |
311 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
243 |
$15K |
| D0603 |
|
554 |
552 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,318 |
692 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
93 |
$4K |
| D0272 |
Bitewings - two radiographic images |
218 |
218 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D9430 |
|
39 |
37 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$800.00 |
| D1999 |
|
309 |
299 |
$75.00 |