| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
784 |
160 |
$21K |
| D1120 |
Prophylaxis - child |
542 |
540 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
341 |
339 |
$16K |
| D1206 |
Topical application of fluoride varnish |
779 |
772 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
623 |
616 |
$14K |
| D1110 |
Prophylaxis - adult |
214 |
210 |
$8K |
| D0274 |
Bitewings - four radiographic images |
225 |
220 |
$7K |
| D0272 |
Bitewings - two radiographic images |
385 |
383 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
63 |
$5K |
| D1330 |
|
644 |
638 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
41 |
$3K |
| D0602 |
|
267 |
265 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
35 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
249 |
246 |
$2K |
| D0603 |
|
204 |
202 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
210 |
207 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
63 |
63 |
$1K |
| D0601 |
|
52 |
49 |
$504.70 |