| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
714 |
706 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
618 |
611 |
$16K |
| D1206 |
Topical application of fluoride varnish |
874 |
861 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
118 |
106 |
$3K |
| D0272 |
Bitewings - two radiographic images |
193 |
189 |
$3K |
| D0602 |
|
321 |
319 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
61 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
59 |
$2K |
| D0240 |
|
104 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
116 |
108 |
$1K |
| D0330 |
Panoramic radiographic image |
40 |
39 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$564.00 |
| D0603 |
|
54 |
54 |
$539.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
25 |
$234.00 |
| D1999 |
|
226 |
213 |
$203.00 |
| D9215 |
|
45 |
42 |
$0.00 |
| D1330 |
|
27 |
27 |
$0.00 |
| D0171 |
|
25 |
25 |
$0.00 |