| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
552 |
534 |
$16K |
| D1206 |
Topical application of fluoride varnish |
721 |
695 |
$12K |
| D0274 |
Bitewings - four radiographic images |
366 |
354 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
385 |
371 |
$8K |
| D1351 |
Sealant - per tooth |
200 |
25 |
$5K |
| D1110 |
Prophylaxis - adult |
86 |
84 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
82 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
80 |
$2K |
| D0330 |
Panoramic radiographic image |
60 |
59 |
$2K |
| D0272 |
Bitewings - two radiographic images |
34 |
32 |
$691.37 |
| D0240 |
|
23 |
12 |
$400.68 |
| D1330 |
|
31 |
31 |
$0.00 |
| D1999 |
|
61 |
56 |
$0.00 |