| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
881 |
876 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,231 |
1,224 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
596 |
505 |
$20K |
| D0272 |
Bitewings - two radiographic images |
502 |
494 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
434 |
$8K |
| D1120 |
Prophylaxis - child |
105 |
104 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
24 |
$3K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$132.21 |