| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
203 |
200 |
$8K |
| D1206 |
Topical application of fluoride varnish |
199 |
195 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
130 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
91 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
70 |
68 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
185 |
111 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
166 |
$907.20 |
| D9310 |
|
14 |
12 |
$205.20 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$94.00 |