| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,180 |
2,149 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,089 |
2,062 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,877 |
1,848 |
$35K |
| D0272 |
Bitewings - two radiographic images |
738 |
725 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
209 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
383 |
377 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
376 |
363 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
368 |
207 |
$3K |
| D1351 |
Sealant - per tooth |
121 |
38 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
41 |
$599.94 |