| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,049 |
577 |
$18K |
| D1351 |
Sealant - per tooth |
601 |
90 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
438 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
790 |
654 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
838 |
660 |
$8K |
| D1120 |
Prophylaxis - child |
279 |
213 |
$7K |
| D0274 |
Bitewings - four radiographic images |
233 |
200 |
$6K |
| D1110 |
Prophylaxis - adult |
69 |
56 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
30 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
61 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
21 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
17 |
$406.65 |
| D0603 |
|
1,337 |
1,115 |
$0.00 |