| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
463 |
449 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
242 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
256 |
249 |
$7K |
| D0272 |
Bitewings - two radiographic images |
306 |
296 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
53 |
$7K |
| D1206 |
Topical application of fluoride varnish |
516 |
495 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
480 |
453 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
502 |
399 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
69 |
67 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
42 |
$1K |
| D0603 |
|
923 |
888 |
$0.00 |
| D0601 |
|
44 |
42 |
$0.00 |