| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
983 |
972 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
482 |
476 |
$34K |
| D2161 |
|
372 |
129 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
447 |
435 |
$28K |
| D1351 |
Sealant - per tooth |
467 |
120 |
$17K |
| D1206 |
Topical application of fluoride varnish |
977 |
964 |
$15K |
| D0274 |
Bitewings - four radiographic images |
657 |
650 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,721 |
996 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
107 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
29 |
$3K |
| D2160 |
|
28 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
141 |
140 |
$2K |