| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,286 |
3,106 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,651 |
3,479 |
$112K |
| D1206 |
Topical application of fluoride varnish |
4,121 |
3,919 |
$75K |
| D1110 |
Prophylaxis - adult |
963 |
931 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,511 |
1,435 |
$39K |
| D1351 |
Sealant - per tooth |
1,170 |
499 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
174 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
157 |
138 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
54 |
$3K |
| D0274 |
Bitewings - four radiographic images |
92 |
92 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
12 |
$574.08 |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
31 |
$558.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$518.18 |
| D9987 |
|
94 |
92 |
$0.00 |
| D1999 |
|
582 |
536 |
$0.00 |
| D9986 |
|
14 |
14 |
$0.00 |