| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
358 |
345 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
353 |
340 |
$12K |
| D1110 |
Prophylaxis - adult |
225 |
219 |
$11K |
| D1206 |
Topical application of fluoride varnish |
623 |
598 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
256 |
249 |
$7K |
| D0330 |
Panoramic radiographic image |
203 |
191 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
37 |
$6K |
| D0274 |
Bitewings - four radiographic images |
237 |
230 |
$6K |
| D0272 |
Bitewings - two radiographic images |
238 |
228 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
100 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$1K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$1K |
| D0603 |
|
486 |
464 |
$0.00 |
| D0602 |
|
286 |
276 |
$0.00 |
| D9910 |
|
47 |
19 |
$0.00 |