| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,432 |
1,371 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,483 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,657 |
1,591 |
$26K |
| D0272 |
Bitewings - two radiographic images |
909 |
873 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
451 |
420 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
727 |
679 |
$8K |
| D0330 |
Panoramic radiographic image |
169 |
158 |
$7K |
| D1354 |
|
174 |
46 |
$4K |
| D1110 |
Prophylaxis - adult |
102 |
98 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
81 |
70 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
38 |
$593.00 |
| D1351 |
Sealant - per tooth |
25 |
12 |
$572.00 |
| D9630 |
|
12 |
12 |
$0.00 |