| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
398 |
384 |
$13K |
| D1206 |
Topical application of fluoride varnish |
432 |
415 |
$12K |
| D1120 |
Prophylaxis - child |
263 |
256 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
87 |
$6K |
| D0272 |
Bitewings - two radiographic images |
121 |
121 |
$2K |
| D1351 |
Sealant - per tooth |
40 |
12 |
$2K |
| D1354 |
|
51 |
20 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$604.20 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$270.96 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$117.96 |
| D0603 |
|
41 |
40 |
$0.00 |