| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
735 |
718 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
53 |
$10K |
| D1120 |
Prophylaxis - child |
210 |
207 |
$8K |
| D1206 |
Topical application of fluoride varnish |
245 |
243 |
$5K |
| D1110 |
Prophylaxis - adult |
71 |
66 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
44 |
41 |
$1K |