| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
610 |
610 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
501 |
$20K |
| D1206 |
Topical application of fluoride varnish |
652 |
652 |
$13K |
| D0272 |
Bitewings - two radiographic images |
159 |
159 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
205 |
205 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
181 |
181 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
54 |
$1K |