| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,607 |
627 |
$111K |
| D1120 |
Prophylaxis - child |
1,586 |
1,405 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,982 |
1,281 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,873 |
1,654 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,086 |
1,035 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,557 |
1,391 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
723 |
$18K |
| D0274 |
Bitewings - four radiographic images |
388 |
349 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
342 |
$10K |
| D1110 |
Prophylaxis - adult |
248 |
219 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
239 |
202 |
$7K |
| D0330 |
Panoramic radiographic image |
246 |
220 |
$6K |
| D0272 |
Bitewings - two radiographic images |
325 |
281 |
$6K |
| D0240 |
|
39 |
13 |
$231.42 |
| D1999 |
|
13 |
12 |
$0.00 |