| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,382 |
1,373 |
$38K |
| D1120 |
Prophylaxis - child |
1,017 |
1,011 |
$35K |
| D1351 |
Sealant - per tooth |
901 |
150 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,390 |
1,381 |
$19K |
| D1110 |
Prophylaxis - adult |
373 |
371 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,236 |
1,218 |
$15K |
| D0272 |
Bitewings - two radiographic images |
626 |
622 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,186 |
1,141 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$6K |
| D0274 |
Bitewings - four radiographic images |
157 |
155 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
73 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
57 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
100 |
$1K |
| D0603 |
|
1,772 |
1,753 |
$0.00 |