| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
868 |
862 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
518 |
516 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,265 |
1,884 |
$19K |
| D9430 |
|
595 |
537 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,186 |
1,173 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
933 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
80 |
$5K |
| D1310 |
|
64 |
64 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$3K |
| D9993 |
|
24 |
24 |
$2K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
37 |
$1K |
| D0603 |
|
25 |
25 |
$360.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$280.80 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$180.00 |
| D1330 |
|
983 |
970 |
$0.00 |