| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
685 |
671 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
660 |
650 |
$19K |
| D1206 |
Topical application of fluoride varnish |
889 |
876 |
$13K |
| D0272 |
Bitewings - two radiographic images |
508 |
500 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
768 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
60 |
59 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
741 |
683 |
$8K |
| D1110 |
Prophylaxis - adult |
70 |
70 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
97 |
$3K |
| D1351 |
Sealant - per tooth |
59 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
45 |
45 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$988.96 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$298.21 |
| D0602 |
|
178 |
172 |
$0.00 |
| D0603 |
|
783 |
774 |
$0.00 |