| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,837 |
2,784 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,629 |
3,554 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,751 |
3,671 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,136 |
3,071 |
$66K |
| D1110 |
Prophylaxis - adult |
628 |
613 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,204 |
1,137 |
$24K |
| D0330 |
Panoramic radiographic image |
112 |
111 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
53 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |