| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,076 |
1,076 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
932 |
932 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,155 |
1,154 |
$19K |
| D0272 |
Bitewings - two radiographic images |
302 |
302 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
128 |
124 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
127 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
88 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
270 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
53 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$744.60 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$481.92 |
| D0240 |
|
13 |
13 |
$459.12 |