| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,413 |
1,257 |
$34K |
| D1999 |
|
1,831 |
1,567 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,979 |
1,783 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,059 |
1,858 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
341 |
191 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,199 |
903 |
$23K |
| D1110 |
Prophylaxis - adult |
636 |
560 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
185 |
$19K |
| D0330 |
Panoramic radiographic image |
193 |
169 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
555 |
$6K |
| D1206 |
Topical application of fluoride varnish |
244 |
205 |
$5K |
| D0272 |
Bitewings - two radiographic images |
225 |
201 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
294 |
$3K |
| D0274 |
Bitewings - four radiographic images |
86 |
67 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
53 |
$1K |
| D0240 |
|
54 |
27 |
$1K |