| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
142 |
$20K |
| D1120 |
Prophylaxis - child |
374 |
372 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
307 |
305 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
295 |
$6K |
| D1351 |
Sealant - per tooth |
210 |
43 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
471 |
461 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
276 |
276 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
412 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
84 |
83 |
$3K |
| D1206 |
Topical application of fluoride varnish |
97 |
95 |
$1K |
| D0274 |
Bitewings - four radiographic images |
41 |
41 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$488.28 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$439.04 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$325.32 |
| D0602 |
|
362 |
361 |
$0.00 |
| D0603 |
|
313 |
306 |
$0.00 |