| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,586 |
2,483 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,036 |
2,932 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,484 |
2,379 |
$53K |
| D1110 |
Prophylaxis - adult |
814 |
789 |
$38K |
| D0272 |
Bitewings - two radiographic images |
913 |
871 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
525 |
502 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
259 |
237 |
$7K |
| D0274 |
Bitewings - four radiographic images |
187 |
180 |
$6K |
| D1351 |
Sealant - per tooth |
131 |
39 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
58 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$426.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$145.75 |