| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,447 |
1,307 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,373 |
1,347 |
$35K |
| D1110 |
Prophylaxis - adult |
594 |
584 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,291 |
1,212 |
$23K |
| D0330 |
Panoramic radiographic image |
453 |
409 |
$21K |
| D1354 |
|
1,368 |
277 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,080 |
983 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
108 |
$18K |
| D1351 |
Sealant - per tooth |
685 |
233 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
347 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
980 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
400 |
316 |
$12K |
| D1206 |
Topical application of fluoride varnish |
541 |
503 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
875 |
808 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
82 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
115 |
114 |
$5K |
| D3120 |
|
60 |
32 |
$0.00 |
| D0602 |
|
82 |
82 |
$0.00 |
| D0603 |
|
436 |
436 |
$0.00 |