| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,503 |
2,503 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
1,637 |
1,637 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,226 |
2,226 |
$50K |
| D1354 |
|
2,774 |
817 |
$22K |
| D0272 |
Bitewings - two radiographic images |
783 |
783 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
265 |
243 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
196 |
196 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
264 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
133 |
133 |
$5K |
| D0274 |
Bitewings - four radiographic images |
83 |
83 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
53 |
$2K |
| D1351 |
Sealant - per tooth |
42 |
14 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
84 |
$1K |