| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
3,492 |
799 |
$32K |
| D1351 |
Sealant - per tooth |
881 |
152 |
$22K |
| D1120 |
Prophylaxis - child |
639 |
571 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
112 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
447 |
396 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
839 |
$10K |
| D1206 |
Topical application of fluoride varnish |
737 |
651 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
280 |
245 |
$7K |
| D9248 |
|
54 |
52 |
$6K |
| D1110 |
Prophylaxis - adult |
77 |
62 |
$3K |
| D0272 |
Bitewings - two radiographic images |
87 |
80 |
$2K |
| D0274 |
Bitewings - four radiographic images |
37 |
33 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
24 |
$542.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
23 |
$264.60 |
| D0603 |
|
1,190 |
1,057 |
$0.00 |