| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,083 |
2,081 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,045 |
2,043 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,169 |
2,167 |
$39K |
| D0272 |
Bitewings - two radiographic images |
805 |
803 |
$15K |
| D1351 |
Sealant - per tooth |
147 |
48 |
$5K |
| D0601 |
|
342 |
342 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
137 |
131 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
281 |
$3K |
| D0603 |
|
193 |
193 |
$2K |
| D1330 |
|
169 |
168 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$1K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$676.00 |
| D0240 |
|
43 |
25 |
$582.60 |
| D1999 |
|
54 |
48 |
$343.00 |