| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,484 |
1,474 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
563 |
558 |
$40K |
| D1310 |
|
1,608 |
1,598 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,461 |
1,453 |
$29K |
| D0272 |
Bitewings - two radiographic images |
915 |
908 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,340 |
1,000 |
$11K |
| D0603 |
|
697 |
691 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
134 |
$7K |
| D9993 |
|
55 |
54 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$3K |
| D1351 |
Sealant - per tooth |
74 |
26 |
$3K |
| D9430 |
|
28 |
26 |
$896.00 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
54 |
$696.00 |
| D1330 |
|
595 |
594 |
$0.00 |