| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
333 |
263 |
$8K |
| D1120 |
Prophylaxis - child |
260 |
205 |
$7K |
| D1206 |
Topical application of fluoride varnish |
344 |
271 |
$4K |
| D0272 |
Bitewings - two radiographic images |
210 |
162 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
283 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
352 |
271 |
$3K |
| D1110 |
Prophylaxis - adult |
33 |
33 |
$2K |
| D0274 |
Bitewings - four radiographic images |
33 |
33 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
41 |
$1K |
| D0602 |
|
346 |
275 |
$0.00 |