| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,130 |
1,084 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
813 |
776 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,912 |
606 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,303 |
1,250 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
747 |
688 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
54 |
52 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
145 |
$5K |
| D1351 |
Sealant - per tooth |
147 |
25 |
$4K |
| D0272 |
Bitewings - two radiographic images |
121 |
116 |
$3K |
| D0240 |
|
122 |
63 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
39 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$346.10 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$244.14 |
| D0601 |
|
237 |
232 |
$0.00 |
| D0603 |
|
676 |
655 |
$0.00 |
| D0602 |
|
136 |
131 |
$0.00 |
| D0703 |
|
15 |
15 |
$0.00 |