| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,994 |
1,938 |
$138K |
| D1110 |
Prophylaxis - adult |
1,177 |
1,137 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
502 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
226 |
139 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,439 |
2,361 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
502 |
390 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
1,472 |
1,431 |
$192.00 |
| D1206 |
Topical application of fluoride varnish |
3,058 |
2,970 |
$90.00 |
| D9986 |
|
30 |
28 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
52 |
$0.00 |
| D1330 |
|
2,896 |
2,806 |
$0.00 |
| D0601 |
|
281 |
270 |
$0.00 |
| D0602 |
|
47 |
47 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
41 |
$0.00 |