| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
379 |
317 |
$4K |
| D1120 |
Prophylaxis - child |
212 |
177 |
$3K |
| D0274 |
Bitewings - four radiographic images |
233 |
191 |
$3K |
| D1351 |
Sealant - per tooth |
282 |
60 |
$2K |
| D1110 |
Prophylaxis - adult |
134 |
109 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
349 |
306 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
404 |
340 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
398 |
333 |
$2K |
| D0272 |
Bitewings - two radiographic images |
94 |
75 |
$759.85 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$162.72 |
| D0602 |
|
134 |
100 |
$0.00 |
| D0603 |
|
293 |
253 |
$0.00 |