| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
541 |
535 |
$15K |
| D1110 |
Prophylaxis - adult |
228 |
224 |
$12K |
| D1120 |
Prophylaxis - child |
334 |
332 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
39 |
$9K |
| D0274 |
Bitewings - four radiographic images |
260 |
254 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
558 |
552 |
$8K |
| D1351 |
Sealant - per tooth |
247 |
72 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
30 |
$6K |
| D0330 |
Panoramic radiographic image |
142 |
138 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
160 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$4K |
| D0272 |
Bitewings - two radiographic images |
160 |
160 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
267 |
94 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
138 |
$2K |
| D0603 |
|
638 |
636 |
$0.00 |