| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
549 |
542 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
929 |
920 |
$24K |
| D0272 |
Bitewings - two radiographic images |
814 |
806 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
769 |
764 |
$15K |
| D1120 |
Prophylaxis - child |
314 |
312 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
498 |
487 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
147 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
239 |
235 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
41 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$372.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$250.80 |