| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
252 |
252 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
264 |
263 |
$7K |
| D1206 |
Topical application of fluoride varnish |
199 |
199 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
160 |
159 |
$963.48 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$910.00 |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$632.13 |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
141 |
$567.60 |