| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,677 |
1,670 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,031 |
2,016 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,250 |
2,234 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,178 |
1,170 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,045 |
1,006 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
844 |
831 |
$12K |
| D1120 |
Prophylaxis - child |
297 |
294 |
$10K |
| D0602 |
|
714 |
706 |
$3K |
| D0601 |
|
592 |
591 |
$3K |
| D9920 |
|
109 |
108 |
$2K |
| D1351 |
Sealant - per tooth |
67 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$957.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
24 |
$681.60 |