| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
981 |
929 |
$28K |
| D1120 |
Prophylaxis - child |
608 |
575 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
422 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,249 |
509 |
$12K |
| D1351 |
Sealant - per tooth |
320 |
39 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
202 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
243 |
230 |
$6K |
| D0274 |
Bitewings - four radiographic images |
271 |
262 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
359 |
332 |
$3K |
| D9995 |
|
337 |
323 |
$3K |
| D1353 |
|
86 |
13 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
39 |
$860.00 |
| D9993 |
|
215 |
205 |
$750.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
37 |
$608.52 |
| D0999 |
Unspecified diagnostic procedure, by report |
14 |
14 |
$420.00 |
| D0602 |
|
38 |
37 |
$175.00 |
| D0603 |
|
225 |
184 |
$145.00 |
| D0601 |
|
28 |
28 |
$110.50 |