| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
263 |
259 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
283 |
277 |
$6K |
| D1206 |
Topical application of fluoride varnish |
317 |
310 |
$5K |
| D1351 |
Sealant - per tooth |
184 |
31 |
$4K |
| D0272 |
Bitewings - two radiographic images |
148 |
144 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
67 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
86 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
47 |
$1K |
| D1110 |
Prophylaxis - adult |
39 |
37 |
$1K |
| D0274 |
Bitewings - four radiographic images |
47 |
45 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
36 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
100 |
$1K |