| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,651 |
1,616 |
$53K |
| D1120 |
Prophylaxis - child |
1,328 |
1,297 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,358 |
1,334 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,055 |
1,042 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
278 |
169 |
$34K |
| D1110 |
Prophylaxis - adult |
387 |
383 |
$23K |
| D0330 |
Panoramic radiographic image |
267 |
253 |
$21K |
| D1351 |
Sealant - per tooth |
218 |
74 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
88 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
65 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
16 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$771.00 |