| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
764 |
699 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
889 |
632 |
$8K |
| D1206 |
Topical application of fluoride varnish |
136 |
132 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
443 |
413 |
$7K |
| D1120 |
Prophylaxis - child |
119 |
114 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
76 |
$2K |
| D0330 |
Panoramic radiographic image |
46 |
44 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
53 |
$1K |
| D0272 |
Bitewings - two radiographic images |
57 |
54 |
$989.44 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$907.40 |
| D0240 |
|
24 |
12 |
$282.80 |