| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
659 |
557 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,006 |
843 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
948 |
807 |
$18K |
| D0272 |
Bitewings - two radiographic images |
743 |
643 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
69 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
402 |
$8K |
| D1120 |
Prophylaxis - child |
162 |
136 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
420 |
314 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
140 |
100 |
$4K |
| D9920 |
|
180 |
174 |
$3K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$910.50 |
| D0140 |
Limited oral evaluation - problem focused |
23 |
12 |
$757.53 |