| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,140 |
6,069 |
$211K |
| D1206 |
Topical application of fluoride varnish |
9,536 |
9,431 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
7,080 |
6,999 |
$171K |
| D1110 |
Prophylaxis - adult |
2,349 |
2,316 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,046 |
1,031 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,742 |
1,727 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
782 |
750 |
$25K |
| D0330 |
Panoramic radiographic image |
443 |
433 |
$24K |
| D0274 |
Bitewings - four radiographic images |
577 |
573 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
30 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$242.90 |