| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
959 |
897 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,055 |
990 |
$20K |
| D1120 |
Prophylaxis - child |
622 |
590 |
$16K |
| D1110 |
Prophylaxis - adult |
357 |
321 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
310 |
264 |
$11K |
| D1351 |
Sealant - per tooth |
351 |
70 |
$10K |
| D0603 |
|
602 |
553 |
$6K |
| D1330 |
|
793 |
728 |
$4K |
| D0272 |
Bitewings - two radiographic images |
226 |
226 |
$4K |
| D9920 |
|
67 |
57 |
$4K |
| D0274 |
Bitewings - four radiographic images |
92 |
92 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$546.09 |
| D1310 |
|
22 |
22 |
$264.87 |
| D0602 |
|
15 |
15 |
$152.40 |
| D0601 |
|
14 |
14 |
$141.20 |
| D1999 |
|
39 |
29 |
$0.21 |