| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,074 |
1,058 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
234 |
$15K |
| D1110 |
Prophylaxis - adult |
122 |
120 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,201 |
1,185 |
$6K |
| D1351 |
Sealant - per tooth |
199 |
60 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
1,019 |
$1K |
| D1330 |
|
1,356 |
1,337 |
$173.06 |
| D0272 |
Bitewings - two radiographic images |
800 |
785 |
$162.75 |
| D1206 |
Topical application of fluoride varnish |
1,408 |
1,360 |
$52.84 |
| D0274 |
Bitewings - four radiographic images |
117 |
116 |
$26.35 |
| D0220 |
Intraoral - periapical first radiographic image |
1,275 |
1,260 |
$10.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$0.00 |