| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
423 |
395 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
529 |
494 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
76 |
71 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
536 |
500 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
565 |
280 |
$6K |
| D0272 |
Bitewings - two radiographic images |
267 |
243 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
195 |
171 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
327 |
$4K |
| D1110 |
Prophylaxis - adult |
79 |
75 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
26 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$346.10 |
| D0603 |
|
667 |
623 |
$0.00 |