| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
499 |
471 |
$15K |
| D1110 |
Prophylaxis - adult |
222 |
219 |
$10K |
| D0272 |
Bitewings - two radiographic images |
217 |
215 |
$5K |
| D1206 |
Topical application of fluoride varnish |
250 |
247 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
135 |
134 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
171 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
126 |
118 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
43 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$950.95 |
| D0602 |
|
14 |
14 |
$55.00 |