| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,940 |
2,721 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,166 |
3,833 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,076 |
3,755 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
311 |
$48K |
| D1110 |
Prophylaxis - adult |
1,218 |
1,115 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,258 |
1,175 |
$21K |
| D0330 |
Panoramic radiographic image |
413 |
362 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
483 |
364 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
49 |
$5K |
| D0274 |
Bitewings - four radiographic images |
47 |
38 |
$885.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
16 |
$492.00 |