| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,355 |
6,216 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
6,164 |
6,055 |
$113K |
| D1206 |
Topical application of fluoride varnish |
7,013 |
6,867 |
$105K |
| D0272 |
Bitewings - two radiographic images |
3,059 |
2,994 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,576 |
3,632 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,026 |
3,909 |
$44K |
| D1354 |
|
910 |
253 |
$28K |
| D1351 |
Sealant - per tooth |
866 |
232 |
$22K |
| D0274 |
Bitewings - four radiographic images |
506 |
497 |
$14K |
| D0330 |
Panoramic radiographic image |
261 |
255 |
$12K |
| D1110 |
Prophylaxis - adult |
450 |
444 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
536 |
516 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
278 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
249 |
238 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |