| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
369 |
319 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
405 |
361 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
416 |
362 |
$5K |
| D0272 |
Bitewings - two radiographic images |
195 |
183 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
235 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
232 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
16 |
$1K |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$878.08 |
| D1351 |
Sealant - per tooth |
64 |
17 |
$536.56 |
| D0274 |
Bitewings - four radiographic images |
26 |
24 |
$449.93 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
31 |
$271.10 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$176.60 |
| D0602 |
|
159 |
149 |
$0.00 |
| D0603 |
|
272 |
215 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
59 |
58 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |