| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,778 |
2,757 |
$64K |
| D1120 |
Prophylaxis - child |
1,978 |
1,962 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,727 |
2,706 |
$53K |
| D0272 |
Bitewings - two radiographic images |
616 |
609 |
$11K |
| D1110 |
Prophylaxis - adult |
218 |
216 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
216 |
$3K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$2K |
| D0274 |
Bitewings - four radiographic images |
28 |
27 |
$665.16 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$413.56 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$292.50 |
| D1999 |
|
543 |
509 |
$0.00 |