| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
699 |
668 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,019 |
980 |
$24K |
| D1120 |
Prophylaxis - child |
384 |
374 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
547 |
499 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
686 |
667 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
176 |
174 |
$3K |
| D0272 |
Bitewings - two radiographic images |
151 |
146 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
95 |
$816.61 |
| D2160 |
|
13 |
12 |
$767.59 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
46 |
$273.00 |