| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
372 |
353 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
417 |
395 |
$11K |
| D1351 |
Sealant - per tooth |
375 |
83 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
833 |
383 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
39 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
49 |
48 |
$6K |
| D1206 |
Topical application of fluoride varnish |
473 |
450 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
606 |
570 |
$6K |
| D0274 |
Bitewings - four radiographic images |
119 |
116 |
$4K |
| D0272 |
Bitewings - two radiographic images |
139 |
133 |
$3K |
| D1110 |
Prophylaxis - adult |
59 |
57 |
$3K |
| D0330 |
Panoramic radiographic image |
76 |
73 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80 |
68 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
51 |
$2K |
| D0603 |
|
541 |
516 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0602 |
|
47 |
44 |
$0.00 |