| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
290 |
279 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
123 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
27 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
71 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$753.00 |
| D0120 |
Periodic oral evaluation - established patient |
233 |
224 |
$536.00 |
| D0220 |
Intraoral - periapical first radiographic image |
178 |
173 |
$0.00 |
| D1330 |
|
299 |
288 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
535 |
147 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
365 |
351 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
209 |
198 |
$0.00 |