| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
223 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,123 |
1,039 |
$29K |
| D1351 |
Sealant - per tooth |
1,199 |
276 |
$28K |
| D0145 |
Oral evaluation for a patient under three years of age |
193 |
185 |
$26K |
| D1120 |
Prophylaxis - child |
660 |
634 |
$22K |
| D1110 |
Prophylaxis - adult |
461 |
419 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,120 |
1,055 |
$15K |
| D0330 |
Panoramic radiographic image |
225 |
204 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
467 |
391 |
$11K |
| D0274 |
Bitewings - four radiographic images |
297 |
260 |
$8K |
| D0272 |
Bitewings - two radiographic images |
145 |
134 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
71 |
$824.42 |
| D0603 |
|
1,553 |
1,455 |
$0.00 |