| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,170 |
3,067 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
2,908 |
2,826 |
$17K |
| D1206 |
Topical application of fluoride varnish |
3,211 |
3,106 |
$13K |
| D0272 |
Bitewings - two radiographic images |
2,086 |
2,017 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
354 |
345 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
613 |
581 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
186 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
286 |
210 |
$840.36 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
214 |
189 |
$803.17 |
| D1110 |
Prophylaxis - adult |
41 |
40 |
$693.84 |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$310.25 |
| D1354 |
|
39 |
13 |
$159.28 |