| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,162 |
1,161 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,421 |
1,420 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
985 |
985 |
$44K |
| D9920 |
|
704 |
653 |
$35K |
| D0272 |
Bitewings - two radiographic images |
836 |
835 |
$28K |
| D0160 |
|
284 |
284 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,144 |
1,139 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,054 |
1,052 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
27 |
$840.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$540.00 |
| D0603 |
|
44 |
44 |
$410.00 |