| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
809 |
543 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
699 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,020 |
659 |
$18K |
| D0272 |
Bitewings - two radiographic images |
863 |
577 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
271 |
149 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
79 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
29 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$864.50 |
| D0603 |
|
116 |
85 |
$385.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$0.00 |