| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
885 |
846 |
$53K |
| D1110 |
Prophylaxis - adult |
202 |
189 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
108 |
$8K |
| D0272 |
Bitewings - two radiographic images |
593 |
568 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
32 |
$5K |
| D1351 |
Sealant - per tooth |
253 |
66 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
884 |
844 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
44 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
106 |
104 |
$609.14 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,098 |
1,047 |
$271.95 |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
858 |
$168.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,021 |
811 |
$22.05 |
| D1330 |
|
1,054 |
1,006 |
$21.00 |
| D0274 |
Bitewings - four radiographic images |
81 |
69 |
$0.00 |