| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,311 |
2,292 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
2,681 |
2,667 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,298 |
2,276 |
$41K |
| D0274 |
Bitewings - four radiographic images |
697 |
689 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
595 |
$9K |
| D1351 |
Sealant - per tooth |
168 |
30 |
$5K |
| D0602 |
|
682 |
679 |
$4K |
| D1110 |
Prophylaxis - adult |
84 |
84 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
155 |
95 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
54 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
58 |
$1K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$712.30 |
| D0601 |
|
90 |
90 |
$514.00 |
| D0603 |
|
94 |
94 |
$480.00 |
| D1999 |
|
63 |
61 |
$427.00 |
| D1310 |
|
87 |
87 |
$290.00 |
| D1330 |
|
87 |
87 |
$30.00 |
| D0350 |
|
13 |
13 |
$0.00 |