| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,010 |
872 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,005 |
873 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
487 |
423 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
425 |
355 |
$10K |
| D0272 |
Bitewings - two radiographic images |
448 |
358 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
61 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,177 |
752 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
720 |
676 |
$5K |
| D0274 |
Bitewings - four radiographic images |
205 |
176 |
$4K |
| D1351 |
Sealant - per tooth |
204 |
62 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
211 |
172 |
$3K |
| D0603 |
|
660 |
563 |
$3K |
| D1354 |
|
223 |
47 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
77 |
$2K |
| D2160 |
|
20 |
13 |
$2K |
| D9630 |
|
172 |
140 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
18 |
15 |
$225.50 |
| D0350 |
|
184 |
153 |
$205.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
13 |
$102.40 |
| D0601 |
|
13 |
13 |
$55.00 |
| D9215 |
|
91 |
76 |
$12.30 |