| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
757 |
196 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
524 |
$15K |
| D1120 |
Prophylaxis - child |
408 |
400 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
99 |
95 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
86 |
$11K |
| D1110 |
Prophylaxis - adult |
188 |
185 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
598 |
587 |
$8K |
| D0272 |
Bitewings - two radiographic images |
375 |
368 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
48 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
794 |
605 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
623 |
609 |
$7K |
| D0274 |
Bitewings - four radiographic images |
188 |
185 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
125 |
$3K |
| D0330 |
Panoramic radiographic image |
79 |
76 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
33 |
$1K |
| D0603 |
|
764 |
749 |
$0.00 |