| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,888 |
1,639 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,357 |
1,185 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,100 |
942 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
598 |
525 |
$23K |
| D0330 |
Panoramic radiographic image |
308 |
268 |
$13K |
| D1351 |
Sealant - per tooth |
432 |
62 |
$10K |
| D0272 |
Bitewings - two radiographic images |
422 |
371 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
248 |
215 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
273 |
213 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
27 |
$4K |
| D1110 |
Prophylaxis - adult |
36 |
15 |
$0.00 |