| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
362 |
338 |
$10K |
| D1110 |
Prophylaxis - adult |
178 |
165 |
$9K |
| D0272 |
Bitewings - two radiographic images |
280 |
258 |
$7K |
| D1120 |
Prophylaxis - child |
183 |
170 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
296 |
272 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
244 |
220 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
225 |
205 |
$3K |
| D2140 |
|
21 |
14 |
$1K |
| D0601 |
|
256 |
237 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$771.40 |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$658.35 |
| D0602 |
|
20 |
19 |
$100.00 |