| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,490 |
2,393 |
$85K |
| D0145 |
Oral evaluation for a patient under three years of age |
629 |
593 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,908 |
2,805 |
$79K |
| D1351 |
Sealant - per tooth |
2,795 |
418 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,253 |
3,130 |
$45K |
| D1110 |
Prophylaxis - adult |
861 |
835 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,107 |
2,024 |
$41K |
| D0274 |
Bitewings - four radiographic images |
960 |
928 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
834 |
773 |
$21K |
| D0330 |
Panoramic radiographic image |
641 |
606 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
154 |
92 |
$14K |
| D0240 |
|
1,287 |
578 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
290 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
72 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
48 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
12 |
$3K |
| D0601 |
|
729 |
699 |
$0.00 |
| D0602 |
|
2,542 |
2,457 |
$0.00 |
| D0603 |
|
634 |
626 |
$0.00 |