| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,945 |
1,845 |
$43K |
| D1110 |
Prophylaxis - adult |
748 |
717 |
$31K |
| D1120 |
Prophylaxis - child |
954 |
926 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
90 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
162 |
147 |
$4K |
| D0274 |
Bitewings - four radiographic images |
125 |
121 |
$4K |
| D0272 |
Bitewings - two radiographic images |
91 |
87 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$1K |