| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
810 |
801 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,008 |
988 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
880 |
862 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
349 |
335 |
$11K |
| D1110 |
Prophylaxis - adult |
190 |
185 |
$7K |
| D0272 |
Bitewings - two radiographic images |
299 |
292 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
36 |
$4K |
| D0603 |
|
387 |
383 |
$4K |
| D1351 |
Sealant - per tooth |
79 |
16 |
$2K |
| D1330 |
|
357 |
340 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
68 |
$635.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$627.54 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$422.30 |
| D0601 |
|
37 |
37 |
$372.00 |
| D0602 |
|
30 |
30 |
$290.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$91.00 |