| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,539 |
5,457 |
$193K |
| D0120 |
Periodic oral evaluation - established patient |
5,298 |
5,234 |
$130K |
| D1206 |
Topical application of fluoride varnish |
5,950 |
5,871 |
$119K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,116 |
2,083 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
2,965 |
2,910 |
$38K |
| D1110 |
Prophylaxis - adult |
723 |
711 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
250 |
149 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
799 |
760 |
$25K |
| D0272 |
Bitewings - two radiographic images |
561 |
554 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
36 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
156 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
52 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
14 |
$2K |
| D0240 |
|
24 |
24 |
$631.86 |