| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,162 |
2,056 |
$110K |
| D1206 |
Topical application of fluoride varnish |
3,535 |
3,411 |
$105K |
| D1120 |
Prophylaxis - child |
3,544 |
3,419 |
$96K |
| D9999 |
Unspecified adjunctive procedure, by report |
2,645 |
2,543 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,166 |
2,108 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
563 |
513 |
$14K |
| D0272 |
Bitewings - two radiographic images |
933 |
892 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
106 |
$3K |
| D0240 |
|
248 |
127 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$936.10 |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
40 |
$340.82 |
| D1354 |
|
36 |
13 |
$134.40 |