| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
612 |
$25K |
| D1120 |
Prophylaxis - child |
870 |
796 |
$23K |
| D0330 |
Panoramic radiographic image |
384 |
356 |
$15K |
| D1206 |
Topical application of fluoride varnish |
559 |
514 |
$13K |
| D1351 |
Sealant - per tooth |
411 |
87 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
290 |
269 |
$10K |
| D0272 |
Bitewings - two radiographic images |
203 |
179 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
236 |
212 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
91 |
83 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
66 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
78 |
$921.40 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$795.84 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$368.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
12 |
$127.74 |