| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,294 |
1,190 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,219 |
1,135 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,583 |
1,197 |
$26K |
| D0272 |
Bitewings - two radiographic images |
999 |
917 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,396 |
1,293 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,420 |
1,291 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
110 |
$15K |
| D1351 |
Sealant - per tooth |
264 |
69 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
114 |
$4K |
| D1110 |
Prophylaxis - adult |
59 |
56 |
$3K |
| D0274 |
Bitewings - four radiographic images |
63 |
61 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
38 |
$975.96 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
12 |
$847.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
14 |
$205.80 |
| D0603 |
|
1,974 |
1,848 |
$0.00 |