| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
266 |
175 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
272 |
142 |
$4K |
| D1120 |
Prophylaxis - child |
200 |
104 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
179 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
109 |
$2K |
| D1110 |
Prophylaxis - adult |
61 |
42 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
28 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
34 |
$599.85 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$586.44 |
| D0274 |
Bitewings - four radiographic images |
22 |
13 |
$436.15 |