| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,550 |
1,296 |
$33K |
| D1120 |
Prophylaxis - child |
946 |
817 |
$31K |
| D1310 |
|
654 |
554 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
828 |
788 |
$22K |
| D1351 |
Sealant - per tooth |
701 |
122 |
$19K |
| D1330 |
|
654 |
553 |
$17K |
| D0330 |
Panoramic radiographic image |
252 |
241 |
$15K |
| D0272 |
Bitewings - two radiographic images |
585 |
539 |
$13K |
| D0603 |
|
851 |
705 |
$9K |
| D9630 |
|
582 |
492 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
185 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
222 |
188 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
13 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
231 |
$5K |
| D1110 |
Prophylaxis - adult |
31 |
30 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$966.31 |
| D0425 |
|
40 |
15 |
$619.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
27 |
$467.92 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$379.83 |