| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,964 |
4,836 |
$465K |
| D1120 |
Prophylaxis - child |
4,276 |
4,179 |
$29K |
| D1351 |
Sealant - per tooth |
612 |
87 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,543 |
2,625 |
$15K |
| D0272 |
Bitewings - two radiographic images |
2,511 |
2,451 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,718 |
2,628 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
883 |
866 |
$9K |
| D1206 |
Topical application of fluoride varnish |
2,574 |
2,491 |
$7K |
| D1110 |
Prophylaxis - adult |
600 |
569 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$3K |
| D0274 |
Bitewings - four radiographic images |
710 |
673 |
$3K |
| D2161 |
|
26 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$1K |
| D2160 |
|
38 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
16 |
$283.40 |