| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
565 |
560 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
442 |
442 |
$8K |
| D1206 |
Topical application of fluoride varnish |
514 |
509 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
80 |
$3K |
| D0272 |
Bitewings - two radiographic images |
119 |
119 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$741.00 |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
54 |
$601.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
12 |
$255.78 |