| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
751 |
735 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
789 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
148 |
148 |
$21K |
| D0272 |
Bitewings - two radiographic images |
645 |
631 |
$15K |
| D1351 |
Sealant - per tooth |
511 |
94 |
$14K |
| D1206 |
Topical application of fluoride varnish |
933 |
915 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
955 |
929 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
928 |
877 |
$10K |
| D1110 |
Prophylaxis - adult |
124 |
122 |
$7K |
| D0274 |
Bitewings - four radiographic images |
110 |
108 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
85 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
26 |
$759.08 |
| D0602 |
|
64 |
64 |
$0.00 |
| D0603 |
|
1,039 |
1,018 |
$0.00 |