| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
31 |
$4K |
| D1120 |
Prophylaxis - child |
80 |
79 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
99 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
71 |
70 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
108 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$771.92 |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
59 |
$720.30 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$658.56 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$569.31 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$565.12 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$380.71 |
| D1206 |
Topical application of fluoride varnish |
28 |
26 |
$308.70 |
| D0603 |
|
142 |
140 |
$0.00 |