| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,226 |
2,201 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,512 |
2,482 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,996 |
2,958 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,109 |
1,096 |
$22K |
| D1110 |
Prophylaxis - adult |
335 |
329 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
81 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
97 |
$3K |
| D1351 |
Sealant - per tooth |
78 |
24 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
201 |
195 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$2K |