| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,218 |
1,198 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,054 |
1,033 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,451 |
1,421 |
$24K |
| D1351 |
Sealant - per tooth |
447 |
94 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
204 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
170 |
150 |
$7K |
| D0272 |
Bitewings - two radiographic images |
233 |
231 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
92 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$538.02 |