| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,228 |
2,227 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
1,147 |
1,147 |
$73K |
| D1310 |
|
1,109 |
1,109 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,613 |
1,613 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
516 |
$33K |
| D0603 |
|
1,090 |
1,090 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,536 |
898 |
$11K |
| D1206 |
Topical application of fluoride varnish |
340 |
340 |
$5K |
| D0274 |
Bitewings - four radiographic images |
207 |
207 |
$4K |
| D0272 |
Bitewings - two radiographic images |
281 |
281 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
242 |
239 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
32 |
$2K |
| D1351 |
Sealant - per tooth |
40 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
33 |
$1K |
| D0350 |
|
157 |
66 |
$1K |