| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,847 |
2,504 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
2,533 |
2,253 |
$92K |
| D1351 |
Sealant - per tooth |
2,313 |
412 |
$86K |
| D1206 |
Topical application of fluoride varnish |
3,329 |
2,946 |
$73K |
| D0330 |
Panoramic radiographic image |
911 |
796 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
326 |
162 |
$46K |
| D0240 |
|
1,529 |
826 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,186 |
1,037 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,204 |
694 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
132 |
$25K |
| D0274 |
Bitewings - four radiographic images |
463 |
422 |
$22K |
| D1110 |
Prophylaxis - adult |
202 |
191 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
52 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
32 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
39 |
$973.36 |
| D1999 |
|
165 |
138 |
$0.00 |