| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,206 |
938 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,473 |
1,157 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
566 |
$12K |
| D1206 |
Topical application of fluoride varnish |
601 |
568 |
$9K |
| D0272 |
Bitewings - two radiographic images |
131 |
95 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
48 |
43 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
40 |
$1K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$428.23 |