| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,338 |
1,311 |
$37K |
| D1120 |
Prophylaxis - child |
845 |
837 |
$30K |
| D1351 |
Sealant - per tooth |
1,108 |
190 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,393 |
1,375 |
$20K |
| D1110 |
Prophylaxis - adult |
325 |
320 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
56 |
$8K |
| D0272 |
Bitewings - two radiographic images |
127 |
127 |
$3K |
| D0330 |
Panoramic radiographic image |
47 |
45 |
$3K |
| D0274 |
Bitewings - four radiographic images |
78 |
77 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
62 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
39 |
$483.54 |
| D0602 |
|
865 |
841 |
$0.00 |
| D0601 |
|
465 |
460 |
$0.00 |
| D0603 |
|
28 |
28 |
$0.00 |