| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,312 |
2,255 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,189 |
2,132 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,145 |
1,116 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
856 |
838 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
162 |
152 |
$9K |
| D0272 |
Bitewings - two radiographic images |
222 |
220 |
$6K |
| D0274 |
Bitewings - four radiographic images |
78 |
78 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
139 |
133 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
41 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$700.70 |
| D1999 |
|
16 |
16 |
$0.00 |