| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,009 |
966 |
$338.88 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
94 |
$156.00 |
| D1206 |
Topical application of fluoride varnish |
1,064 |
1,028 |
$149.35 |
| D0120 |
Periodic oral evaluation - established patient |
889 |
861 |
$140.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
84 |
$96.00 |
| D0272 |
Bitewings - two radiographic images |
649 |
626 |
$95.91 |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
211 |
$80.00 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$54.00 |
| D0240 |
|
61 |
20 |
$10.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
26 |
$0.00 |
| D1330 |
|
20 |
20 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$0.00 |