| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,428 |
2,186 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,081 |
2,795 |
$50K |
| D1354 |
|
1,489 |
303 |
$50K |
| D1999 |
|
2,635 |
2,046 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,040 |
2,752 |
$39K |
| D1110 |
Prophylaxis - adult |
793 |
692 |
$23K |
| D0330 |
Panoramic radiographic image |
440 |
386 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
590 |
502 |
$10K |
| D0272 |
Bitewings - two radiographic images |
638 |
577 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
52 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
25 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
40 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
362 |
261 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
147 |
$3K |
| D0274 |
Bitewings - four radiographic images |
138 |
124 |
$2K |
| D1206 |
Topical application of fluoride varnish |
128 |
100 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$962.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
40 |
$581.20 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
14 |
$319.00 |