| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
963 |
957 |
$63K |
| D1120 |
Prophylaxis - child |
1,488 |
1,480 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,328 |
$21K |
| D1310 |
|
97 |
97 |
$4K |
| D9993 |
|
84 |
84 |
$4K |
| D0272 |
Bitewings - two radiographic images |
315 |
315 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
401 |
208 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
31 |
$1K |
| D0603 |
|
81 |
81 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
27 |
$372.00 |
| D1999 |
|
332 |
332 |
$184.00 |