| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
198 |
186 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
166 |
$4K |
| D1351 |
Sealant - per tooth |
175 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
149 |
141 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
187 |
177 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
196 |
177 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
157 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
56 |
$975.99 |
| D9310 |
|
23 |
14 |
$43.74 |
| D1206 |
Topical application of fluoride varnish |
19 |
15 |
$22.05 |
| D0602 |
|
73 |
73 |
$0.00 |
| D0603 |
|
92 |
83 |
$0.00 |
| D0601 |
|
48 |
44 |
$0.00 |