| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
359 |
342 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
279 |
275 |
$7K |
| D1120 |
Prophylaxis - child |
223 |
221 |
$6K |
| D1110 |
Prophylaxis - adult |
172 |
168 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
357 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
99 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
266 |
261 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
48 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
103 |
$2K |
| D0274 |
Bitewings - four radiographic images |
27 |
25 |
$704.55 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
27 |
$597.00 |