| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
804 |
459 |
$9K |
| D1120 |
Prophylaxis - child |
669 |
392 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
683 |
386 |
$6K |
| D0272 |
Bitewings - two radiographic images |
443 |
244 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80 |
39 |
$2K |
| D1351 |
Sealant - per tooth |
443 |
102 |
$2K |
| D1110 |
Prophylaxis - adult |
121 |
66 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
274 |
155 |
$876.55 |
| D0603 |
|
77 |
37 |
$0.77 |
| D0601 |
|
24 |
12 |
$0.24 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
144 |
86 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
83 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
97 |
57 |
$0.00 |
| D0330 |
Panoramic radiographic image |
91 |
55 |
$0.00 |