| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,499 |
3,308 |
$181K |
| D1206 |
Topical application of fluoride varnish |
3,495 |
3,306 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,624 |
1,509 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,163 |
1,114 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,262 |
2,110 |
$26K |
| D0272 |
Bitewings - two radiographic images |
950 |
885 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,835 |
2,198 |
$16K |
| D0274 |
Bitewings - four radiographic images |
372 |
356 |
$8K |
| D1351 |
Sealant - per tooth |
192 |
40 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
86 |
86 |
$3K |
| D0603 |
|
554 |
526 |
$3K |
| D0350 |
|
1,085 |
781 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
85 |
85 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
57 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
55 |
$936.56 |
| D0240 |
|
64 |
58 |
$834.26 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
16 |
$465.36 |
| D0602 |
|
33 |
32 |
$135.00 |