| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,454 |
1,319 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,775 |
2,490 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,842 |
2,526 |
$51K |
| D1120 |
Prophylaxis - child |
1,247 |
1,119 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
266 |
$28K |
| D0274 |
Bitewings - four radiographic images |
733 |
654 |
$21K |
| D0330 |
Panoramic radiographic image |
118 |
111 |
$7K |
| D0272 |
Bitewings - two radiographic images |
259 |
233 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
24 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
76 |
58 |
$2K |