| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
324 |
324 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
429 |
429 |
$17K |
| D1206 |
Topical application of fluoride varnish |
503 |
503 |
$17K |
| D1110 |
Prophylaxis - adult |
203 |
203 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
55 |
$13K |
| D0274 |
Bitewings - four radiographic images |
246 |
246 |
$12K |
| D0272 |
Bitewings - two radiographic images |
298 |
298 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
217 |
135 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
240 |
239 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
78 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
16 |
$3K |
| D1351 |
Sealant - per tooth |
62 |
20 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$2K |