| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
539 |
523 |
$18K |
| D1351 |
Sealant - per tooth |
733 |
153 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
70 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
383 |
373 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
693 |
667 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
64 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
312 |
281 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
236 |
$8K |
| D0330 |
Panoramic radiographic image |
121 |
117 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
686 |
420 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
32 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
475 |
451 |
$5K |
| D0272 |
Bitewings - two radiographic images |
243 |
232 |
$5K |
| D0603 |
|
1,140 |
1,094 |
$0.00 |