| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
72 |
$3K |
| D1120 |
Prophylaxis - child |
116 |
110 |
$2K |
| D1206 |
Topical application of fluoride varnish |
117 |
112 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
62 |
46 |
$1K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
90 |
88 |
$913.44 |
| D0120 |
Periodic oral evaluation - established patient |
35 |
35 |
$868.77 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$510.60 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
15 |
$413.70 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
19 |
$395.80 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
43 |
$372.24 |
| D0240 |
|
24 |
13 |
$213.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
67 |
38 |
$156.42 |