| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,891 |
1,860 |
$67K |
| D1351 |
Sealant - per tooth |
2,143 |
306 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,998 |
1,955 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
424 |
129 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,102 |
1,076 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
106 |
$15K |
| D1110 |
Prophylaxis - adult |
181 |
179 |
$9K |
| D0330 |
Panoramic radiographic image |
149 |
148 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
136 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
138 |
134 |
$2K |
| D9248 |
|
14 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$588.37 |
| D0602 |
|
2,809 |
2,737 |
$0.00 |