| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,736 |
1,702 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,035 |
1,998 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,632 |
1,597 |
$22K |
| D0272 |
Bitewings - two radiographic images |
846 |
826 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
743 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
704 |
638 |
$7K |
| D1110 |
Prophylaxis - adult |
102 |
99 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
176 |
175 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
36 |
$698.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
25 |
$644.40 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$335.79 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$225.36 |
| D0601 |
|
696 |
687 |
$0.00 |
| D0603 |
|
1,070 |
1,055 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |