| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,458 |
985 |
$108K |
| D1120 |
Prophylaxis - child |
2,254 |
2,127 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,531 |
2,388 |
$65K |
| D0145 |
Oral evaluation for a patient under three years of age |
352 |
343 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,956 |
2,771 |
$39K |
| D1110 |
Prophylaxis - adult |
605 |
563 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,894 |
648 |
$19K |
| D0274 |
Bitewings - four radiographic images |
490 |
456 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,094 |
966 |
$11K |
| D0272 |
Bitewings - two radiographic images |
399 |
380 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
275 |
254 |
$8K |
| D0240 |
|
720 |
547 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
267 |
$6K |
| D0330 |
Panoramic radiographic image |
104 |
98 |
$6K |
| D1330 |
|
120 |
107 |
$1K |
| D0350 |
|
44 |
41 |
$661.68 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$244.14 |
| D9910 |
|
272 |
233 |
$143.28 |
| D9215 |
|
215 |
184 |
$12.25 |
| D0602 |
|
2,896 |
2,783 |
$0.00 |
| D0603 |
|
399 |
386 |
$0.00 |