| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,432 |
1,402 |
$61K |
| D1351 |
Sealant - per tooth |
3,045 |
512 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,067 |
1,054 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,205 |
1,177 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
515 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
431 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,421 |
1,384 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
516 |
504 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,394 |
1,357 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
338 |
323 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
55 |
$995.76 |