| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,240 |
1,220 |
$33K |
| D1351 |
Sealant - per tooth |
1,107 |
135 |
$28K |
| D0274 |
Bitewings - four radiographic images |
694 |
680 |
$20K |
| D1120 |
Prophylaxis - child |
564 |
550 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,368 |
1,341 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,407 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,390 |
1,292 |
$14K |
| D1110 |
Prophylaxis - adult |
256 |
255 |
$13K |
| D0272 |
Bitewings - two radiographic images |
59 |
58 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
59 |
46 |
$921.74 |
| D0140 |
Limited oral evaluation - problem focused |
94 |
84 |
$727.11 |
| D1330 |
|
31 |
27 |
$110.25 |
| D0601 |
|
1,015 |
996 |
$0.01 |
| D0603 |
|
27 |
25 |
$0.00 |
| D1999 |
|
665 |
609 |
$0.00 |