| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,078 |
3,055 |
$82K |
| D1110 |
Prophylaxis - adult |
1,593 |
1,579 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
650 |
452 |
$57K |
| D1120 |
Prophylaxis - child |
1,615 |
1,606 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,638 |
2,621 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,310 |
1,207 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,609 |
1,589 |
$33K |
| D0330 |
Panoramic radiographic image |
154 |
154 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
48 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
418 |
409 |
$6K |