| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,295 |
2,226 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,145 |
2,090 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,389 |
2,311 |
$39K |
| D0272 |
Bitewings - two radiographic images |
794 |
768 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
52 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
128 |
$2K |
| D1351 |
Sealant - per tooth |
55 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$743.40 |