| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
675 |
664 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
926 |
904 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,076 |
1,059 |
$18K |
| D0272 |
Bitewings - two radiographic images |
906 |
888 |
$18K |
| D1110 |
Prophylaxis - adult |
431 |
421 |
$16K |
| D1351 |
Sealant - per tooth |
589 |
81 |
$15K |
| D2140 |
|
182 |
102 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
186 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
444 |
269 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
51 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$322.85 |