| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
934 |
884 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,025 |
973 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
489 |
464 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
317 |
$8K |
| D0274 |
Bitewings - four radiographic images |
454 |
433 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
107 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
233 |
197 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
273 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
160 |
$2K |
| D0272 |
Bitewings - two radiographic images |
43 |
42 |
$770.29 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$368.93 |