| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,977 |
2,727 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,207 |
2,932 |
$88K |
| D1206 |
Topical application of fluoride varnish |
1,124 |
1,022 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,938 |
1,771 |
$18K |
| D0272 |
Bitewings - two radiographic images |
605 |
556 |
$11K |
| D1351 |
Sealant - per tooth |
454 |
132 |
$9K |
| D9248 |
|
28 |
26 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
65 |
65 |
$2K |
| D1110 |
Prophylaxis - adult |
32 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
77 |
$1K |
| D0274 |
Bitewings - four radiographic images |
30 |
27 |
$565.68 |
| D0603 |
|
75 |
75 |
$383.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$365.64 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
25 |
$364.42 |
| D0602 |
|
25 |
25 |
$126.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$110.34 |
| D0601 |
|
15 |
15 |
$78.75 |