| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,701 |
2,577 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
3,718 |
3,554 |
$47K |
| D1351 |
Sealant - per tooth |
2,503 |
377 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,655 |
2,542 |
$35K |
| D1110 |
Prophylaxis - adult |
1,091 |
1,056 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,209 |
1,151 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,208 |
1,150 |
$17K |
| D0330 |
Panoramic radiographic image |
322 |
308 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
210 |
179 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
141 |
$2K |
| D0601 |
|
140 |
126 |
$0.00 |
| D0603 |
|
546 |
499 |
$0.00 |
| D0602 |
|
35 |
28 |
$0.00 |