| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,588 |
1,548 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,559 |
1,513 |
$32K |
| D1120 |
Prophylaxis - child |
946 |
921 |
$31K |
| D1110 |
Prophylaxis - adult |
636 |
604 |
$26K |
| D0272 |
Bitewings - two radiographic images |
513 |
497 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
161 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
39 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$999.30 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
13 |
$879.23 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
25 |
$410.00 |