| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,331 |
376 |
$38K |
| D1110 |
Prophylaxis - adult |
660 |
644 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,068 |
1,016 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
682 |
661 |
$18K |
| D0274 |
Bitewings - four radiographic images |
798 |
759 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,601 |
1,555 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,920 |
1,435 |
$14K |
| D1120 |
Prophylaxis - child |
485 |
473 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
111 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,296 |
1,249 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
188 |
175 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
57 |
$4K |
| D0272 |
Bitewings - two radiographic images |
80 |
78 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$176.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$145.53 |
| D0601 |
|
1,745 |
1,665 |
$13.87 |
| D0602 |
|
226 |
217 |
$0.10 |
| D0603 |
|
57 |
51 |
$0.02 |