| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
561 |
559 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
541 |
539 |
$16K |
| D1206 |
Topical application of fluoride varnish |
628 |
626 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
27 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
62 |
$3K |
| D0272 |
Bitewings - two radiographic images |
205 |
203 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
131 |
123 |
$2K |
| D1330 |
|
181 |
181 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$405.00 |