| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
914 |
901 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,297 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
594 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
295 |
217 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,117 |
1,100 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
911 |
903 |
$17K |
| D1110 |
Prophylaxis - adult |
377 |
372 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
49 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
110 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$979.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
89 |
$627.45 |
| D9110 |
|
14 |
14 |
$511.98 |
| D0240 |
|
70 |
36 |
$428.12 |