| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,901 |
1,892 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
1,027 |
1,021 |
$73K |
| D1310 |
|
944 |
938 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,888 |
1,881 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
354 |
$24K |
| D0603 |
|
931 |
924 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
95 |
$7K |
| D0272 |
Bitewings - two radiographic images |
493 |
486 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
108 |
$5K |
| D9993 |
|
56 |
56 |
$4K |
| D9430 |
|
14 |
12 |
$448.00 |
| D0240 |
|
24 |
12 |
$240.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
14 |
$97.20 |