| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,203 |
1,162 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
783 |
757 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
667 |
647 |
$16K |
| D0272 |
Bitewings - two radiographic images |
537 |
518 |
$13K |
| D1206 |
Topical application of fluoride varnish |
428 |
416 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
121 |
$7K |
| D1351 |
Sealant - per tooth |
145 |
39 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
231 |
$3K |
| D0240 |
|
226 |
114 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
32 |
$1K |
| D1354 |
|
43 |
16 |
$932.62 |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
13 |
$157.91 |
| D1999 |
|
77 |
73 |
$0.00 |
| D1330 |
|
51 |
50 |
$0.00 |
| D0603 |
|
944 |
916 |
$0.00 |
| D0602 |
|
44 |
44 |
$0.00 |