| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,602 |
2,488 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,254 |
3,113 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,522 |
2,398 |
$54K |
| D1110 |
Prophylaxis - adult |
1,012 |
967 |
$47K |
| D0272 |
Bitewings - two radiographic images |
956 |
908 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
731 |
709 |
$16K |
| D0274 |
Bitewings - four radiographic images |
260 |
247 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
182 |
168 |
$5K |
| D1351 |
Sealant - per tooth |
103 |
27 |
$3K |
| D0240 |
|
117 |
57 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
43 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
12 |
$390.50 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
16 |
$198.75 |