| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
533 |
114 |
$13K |
| D1120 |
Prophylaxis - child |
423 |
408 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
362 |
350 |
$8K |
| D0272 |
Bitewings - two radiographic images |
394 |
380 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
52 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
411 |
396 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
433 |
416 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
456 |
401 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
36 |
28 |
$759.08 |
| D0603 |
|
601 |
580 |
$0.00 |