| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,929 |
3,917 |
$98K |
| D1120 |
Prophylaxis - child |
2,402 |
2,397 |
$88K |
| D1206 |
Topical application of fluoride varnish |
3,755 |
3,745 |
$81K |
| D1110 |
Prophylaxis - adult |
1,374 |
1,368 |
$69K |
| D0272 |
Bitewings - two radiographic images |
981 |
978 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,031 |
1,026 |
$14K |
| D0274 |
Bitewings - four radiographic images |
266 |
266 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$367.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$156.24 |