| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,223 |
2,038 |
$55K |
| D1120 |
Prophylaxis - child |
1,063 |
985 |
$36K |
| D1110 |
Prophylaxis - adult |
557 |
514 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
964 |
864 |
$18K |
| D0272 |
Bitewings - two radiographic images |
291 |
285 |
$7K |
| D1206 |
Topical application of fluoride varnish |
101 |
96 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
83 |
68 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
42 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$451.25 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |