| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,723 |
2,716 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
1,369 |
1,365 |
$90K |
| D1310 |
|
1,819 |
1,815 |
$80K |
| D1206 |
Topical application of fluoride varnish |
2,579 |
2,571 |
$53K |
| D9993 |
|
479 |
477 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
351 |
350 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
231 |
$16K |
| D0240 |
|
1,635 |
841 |
$15K |
| D0603 |
|
882 |
879 |
$12K |
| D0272 |
Bitewings - two radiographic images |
560 |
559 |
$6K |
| D0601 |
|
281 |
281 |
$4K |
| D1351 |
Sealant - per tooth |
46 |
14 |
$2K |
| D0350 |
|
121 |
52 |
$1K |
| D0602 |
|
55 |
55 |
$825.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$520.00 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$252.00 |
| D1999 |
|
32 |
31 |
$0.00 |