| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,395 |
1,315 |
$25K |
| D1120 |
Prophylaxis - child |
836 |
779 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
796 |
750 |
$11K |
| D1110 |
Prophylaxis - adult |
313 |
297 |
$10K |
| D1206 |
Topical application of fluoride varnish |
280 |
257 |
$5K |
| D0272 |
Bitewings - two radiographic images |
246 |
225 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
32 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
98 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| D1999 |
|
138 |
128 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$264.00 |