| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,885 |
1,838 |
$46K |
| D1120 |
Prophylaxis - child |
2,074 |
1,990 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,257 |
2,165 |
$41K |
| D0272 |
Bitewings - two radiographic images |
897 |
843 |
$8K |
| D1351 |
Sealant - per tooth |
362 |
73 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
166 |
162 |
$4K |
| D1999 |
|
362 |
286 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
68 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
26 |
$210.82 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$28.44 |