| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
952 |
911 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
983 |
959 |
$25K |
| D1110 |
Prophylaxis - adult |
368 |
352 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
87 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
275 |
$12K |
| D0272 |
Bitewings - two radiographic images |
528 |
501 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
508 |
495 |
$9K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D1206 |
Topical application of fluoride varnish |
120 |
109 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
53 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
13 |
$176.28 |