| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
443 |
439 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
350 |
347 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
432 |
429 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
273 |
$3K |
| D0272 |
Bitewings - two radiographic images |
218 |
217 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
294 |
168 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
88 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$945.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$104.00 |