| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,329 |
407 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,093 |
2,044 |
$59K |
| D1120 |
Prophylaxis - child |
1,480 |
1,443 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,184 |
1,145 |
$39K |
| D1110 |
Prophylaxis - adult |
684 |
667 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,193 |
2,141 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,941 |
1,883 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,923 |
1,800 |
$21K |
| D0272 |
Bitewings - two radiographic images |
755 |
746 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
118 |
117 |
$16K |
| D0330 |
Panoramic radiographic image |
95 |
95 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
27 |
$813.30 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D1330 |
|
42 |
42 |
$12.25 |
| D0602 |
|
2,272 |
2,224 |
$0.00 |
| D0601 |
|
143 |
140 |
$0.00 |