| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,236 |
1,188 |
$22K |
| D1110 |
Prophylaxis - adult |
467 |
454 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,063 |
1,025 |
$15K |
| D1120 |
Prophylaxis - child |
500 |
480 |
$13K |
| D0272 |
Bitewings - two radiographic images |
455 |
442 |
$8K |
| D0330 |
Panoramic radiographic image |
78 |
74 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
75 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
13 |
$2K |