| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
748 |
739 |
$19K |
| D1110 |
Prophylaxis - adult |
382 |
377 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
422 |
408 |
$7K |
| D1206 |
Topical application of fluoride varnish |
310 |
304 |
$6K |
| D1120 |
Prophylaxis - child |
154 |
154 |
$5K |
| D0272 |
Bitewings - two radiographic images |
208 |
207 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
146 |
146 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
197 |
176 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
70 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$923.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
25 |
$855.00 |
| D0274 |
Bitewings - four radiographic images |
47 |
45 |
$785.10 |
| D0603 |
|
104 |
104 |
$515.00 |