| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
452 |
412 |
$19K |
| D1206 |
Topical application of fluoride varnish |
430 |
391 |
$17K |
| D0274 |
Bitewings - four radiographic images |
306 |
280 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
329 |
301 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
769 |
428 |
$4K |
| D1351 |
Sealant - per tooth |
179 |
24 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
119 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
290 |
252 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
40 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
66 |
$1K |
| D0272 |
Bitewings - two radiographic images |
35 |
31 |
$521.44 |
| D0601 |
|
58 |
58 |
$290.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
19 |
$194.56 |
| D0602 |
|
34 |
34 |
$125.00 |