| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,797 |
2,498 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,372 |
3,875 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,369 |
3,884 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,560 |
4,048 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
4,566 |
4,047 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,496 |
3,972 |
$60K |
| D1120 |
Prophylaxis - child |
1,836 |
1,609 |
$60K |
| D0602 |
|
2,422 |
2,211 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
104 |
69 |
$3K |
| D0603 |
|
413 |
256 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$410.40 |