| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,440 |
3,275 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,741 |
3,547 |
$96K |
| D0272 |
Bitewings - two radiographic images |
2,276 |
2,171 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,390 |
2,322 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,632 |
2,474 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,491 |
2,026 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,318 |
1,220 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
61 |
57 |
$8K |
| D1110 |
Prophylaxis - adult |
164 |
157 |
$7K |
| D0274 |
Bitewings - four radiographic images |
58 |
54 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$894.63 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$423.84 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$299.20 |
| D0602 |
|
1,153 |
1,119 |
$0.00 |
| D0603 |
|
2,197 |
2,116 |
$0.00 |
| D0601 |
|
127 |
119 |
$0.00 |