| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
278 |
265 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
176 |
$6K |
| D1206 |
Topical application of fluoride varnish |
129 |
124 |
$3K |
| D0274 |
Bitewings - four radiographic images |
89 |
84 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
64 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$776.85 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$464.28 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$385.41 |
| D0220 |
Intraoral - periapical first radiographic image |
33 |
29 |
$340.20 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$334.80 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$192.33 |