| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,437 |
1,430 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,376 |
1,369 |
$27K |
| D1120 |
Prophylaxis - child |
1,017 |
1,013 |
$25K |
| D1110 |
Prophylaxis - adult |
436 |
433 |
$17K |
| D0274 |
Bitewings - four radiographic images |
333 |
332 |
$10K |
| D0272 |
Bitewings - two radiographic images |
410 |
408 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
437 |
421 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
73 |
$2K |
| D1351 |
Sealant - per tooth |
119 |
29 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$281.62 |
| D2140 |
|
17 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
44 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
67 |
66 |
$0.00 |