| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
607 |
583 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
765 |
747 |
$7K |
| D1206 |
Topical application of fluoride varnish |
519 |
493 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
79 |
76 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
17 |
$0.00 |
| D1351 |
Sealant - per tooth |
115 |
16 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
65 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$0.00 |
| D0330 |
Panoramic radiographic image |
37 |
36 |
$0.00 |
| D1110 |
Prophylaxis - adult |
163 |
161 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
16 |
$0.00 |