| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
713 |
655 |
$25K |
| D1120 |
Prophylaxis - child |
703 |
648 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
192 |
177 |
$6K |
| D1206 |
Topical application of fluoride varnish |
254 |
251 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
148 |
141 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
17 |
$847.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$575.70 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$432.48 |