| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,254 |
1,252 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,502 |
1,500 |
$22K |
| D0274 |
Bitewings - four radiographic images |
641 |
640 |
$18K |
| D1120 |
Prophylaxis - child |
616 |
615 |
$18K |
| D1110 |
Prophylaxis - adult |
316 |
316 |
$13K |
| D0330 |
Panoramic radiographic image |
94 |
94 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
288 |
287 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
428 |
211 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
66 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
28 |
$768.32 |