| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,821 |
1,781 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,241 |
2,211 |
$62K |
| D1351 |
Sealant - per tooth |
1,956 |
474 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
420 |
213 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,758 |
2,715 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
251 |
249 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,741 |
2,685 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,665 |
2,564 |
$27K |
| D0274 |
Bitewings - four radiographic images |
912 |
893 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,132 |
1,117 |
$25K |
| D1110 |
Prophylaxis - adult |
479 |
473 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
100 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
214 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
50 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$59.07 |
| D9986 |
|
92 |
87 |
$0.00 |
| D0603 |
|
2,341 |
2,279 |
$0.00 |
| D0602 |
|
587 |
577 |
$0.00 |
| D0601 |
|
104 |
98 |
$0.00 |