| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
278 |
274 |
$8K |
| D1120 |
Prophylaxis - child |
198 |
195 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
40 |
$6K |
| D0274 |
Bitewings - four radiographic images |
143 |
141 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
322 |
$4K |
| D1110 |
Prophylaxis - adult |
74 |
73 |
$4K |
| D1206 |
Topical application of fluoride varnish |
273 |
268 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
309 |
302 |
$3K |
| D0272 |
Bitewings - two radiographic images |
104 |
103 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
28 |
$813.30 |
| D0603 |
|
238 |
235 |
$0.00 |
| D0601 |
|
46 |
46 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |