| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
662 |
646 |
$879.66 |
| D0120 |
Periodic oral evaluation - established patient |
1,043 |
1,005 |
$672.87 |
| D1206 |
Topical application of fluoride varnish |
1,485 |
1,427 |
$652.89 |
| D1110 |
Prophylaxis - adult |
647 |
608 |
$452.31 |
| D0220 |
Intraoral - periapical first radiographic image |
824 |
786 |
$274.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
719 |
677 |
$211.69 |
| D0274 |
Bitewings - four radiographic images |
340 |
323 |
$156.70 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$78.72 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$45.18 |
| D0272 |
Bitewings - two radiographic images |
51 |
51 |
$24.14 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
44 |
$22.91 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
122 |
$0.00 |
| D9920 |
|
584 |
512 |
$0.00 |
| D9997 |
|
669 |
589 |
$0.00 |
| D1330 |
|
287 |
256 |
$0.00 |
| D1354 |
|
720 |
158 |
$0.00 |