| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,831 |
3,771 |
$194K |
| D1206 |
Topical application of fluoride varnish |
4,469 |
4,397 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,021 |
3,961 |
$116K |
| D0272 |
Bitewings - two radiographic images |
1,217 |
1,203 |
$36K |
| D1110 |
Prophylaxis - adult |
450 |
440 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
196 |
188 |
$4K |
| D0274 |
Bitewings - four radiographic images |
84 |
84 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
59 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
60 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$262.00 |
| D1999 |
|
406 |
398 |
$0.00 |