| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
741 |
488 |
$21K |
| D1206 |
Topical application of fluoride varnish |
726 |
482 |
$16K |
| D1351 |
Sealant - per tooth |
595 |
77 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
212 |
$6K |
| D0274 |
Bitewings - four radiographic images |
361 |
235 |
$5K |
| D0350 |
|
844 |
432 |
$5K |
| D0330 |
Panoramic radiographic image |
114 |
93 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
714 |
459 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
392 |
218 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
653 |
421 |
$3K |
| D0272 |
Bitewings - two radiographic images |
186 |
108 |
$2K |
| D7111 |
|
95 |
40 |
$2K |
| D0603 |
|
368 |
229 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
60 |
48 |
$840.50 |
| D0140 |
Limited oral evaluation - problem focused |
37 |
23 |
$764.52 |
| D1110 |
Prophylaxis - adult |
23 |
16 |
$345.00 |
| D0602 |
|
100 |
67 |
$300.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
44 |
16 |
$276.60 |