| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
157 |
155 |
$22K |
| D1351 |
Sealant - per tooth |
499 |
82 |
$14K |
| D1120 |
Prophylaxis - child |
348 |
342 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
985 |
391 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
496 |
490 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
203 |
203 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
440 |
424 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
70 |
$2K |
| D0272 |
Bitewings - two radiographic images |
110 |
110 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
45 |
$1K |
| D0603 |
|
793 |
784 |
$0.00 |