| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
860 |
833 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
931 |
906 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,912 |
692 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
137 |
134 |
$19K |
| D1206 |
Topical application of fluoride varnish |
788 |
767 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
820 |
786 |
$9K |
| D0272 |
Bitewings - two radiographic images |
248 |
241 |
$5K |
| D1351 |
Sealant - per tooth |
167 |
29 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
302 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
76 |
$3K |
| D1110 |
Prophylaxis - adult |
50 |
49 |
$2K |
| D0274 |
Bitewings - four radiographic images |
55 |
52 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
27 |
$704.86 |
| D0603 |
|
1,484 |
1,475 |
$0.00 |