| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,332 |
1,309 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,757 |
1,726 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,566 |
1,542 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
124 |
82 |
$15K |
| D1110 |
Prophylaxis - adult |
323 |
318 |
$14K |
| D0603 |
|
1,432 |
1,405 |
$12K |
| D0272 |
Bitewings - two radiographic images |
496 |
491 |
$9K |
| D1351 |
Sealant - per tooth |
80 |
51 |
$8K |
| D1330 |
|
1,283 |
1,257 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
90 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
67 |
66 |
$2K |
| D0274 |
Bitewings - four radiographic images |
44 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
86 |
$868.69 |
| D0330 |
Panoramic radiographic image |
16 |
15 |
$681.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
16 |
$158.84 |
| D1310 |
|
1,283 |
1,258 |
$9.00 |