| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
933 |
895 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
872 |
839 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
472 |
465 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
465 |
$5K |
| D0272 |
Bitewings - two radiographic images |
324 |
301 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
508 |
268 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
84 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
41 |
$874.63 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$453.60 |
| D1330 |
|
55 |
51 |
$0.00 |
| D0191 |
|
12 |
12 |
$0.00 |