| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
835 |
828 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,110 |
1,097 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
829 |
819 |
$21K |
| D0272 |
Bitewings - two radiographic images |
644 |
636 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
785 |
$14K |
| D1110 |
Prophylaxis - adult |
282 |
276 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
830 |
742 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
275 |
240 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
138 |
136 |
$5K |
| D0603 |
|
681 |
671 |
$3K |
| D0240 |
|
24 |
12 |
$543.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$438.90 |
| D0602 |
|
116 |
116 |
$430.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$360.50 |