| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,635 |
737 |
$360K |
| D1206 |
Topical application of fluoride varnish |
1,111 |
549 |
$48K |
| D1351 |
Sealant - per tooth |
859 |
136 |
$47K |
| D1120 |
Prophylaxis - child |
690 |
347 |
$46K |
| D1354 |
|
726 |
125 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
565 |
285 |
$28K |
| D0272 |
Bitewings - two radiographic images |
548 |
275 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
344 |
172 |
$23K |
| D0330 |
Panoramic radiographic image |
171 |
86 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
95 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
149 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
27 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
83 |
$5K |
| D1353 |
|
50 |
12 |
$3K |