| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
203 |
202 |
$5K |
| D1120 |
Prophylaxis - child |
58 |
58 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
63 |
63 |
$2K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$2K |
| D0274 |
Bitewings - four radiographic images |
82 |
80 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
164 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$2K |
| D1206 |
Topical application of fluoride varnish |
48 |
48 |
$1K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$598.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
50 |
$517.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$325.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$193.70 |
| D1999 |
|
87 |
79 |
$0.00 |