| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,635 |
2,427 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
4,505 |
4,187 |
$78K |
| D1120 |
Prophylaxis - child |
2,499 |
2,321 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,358 |
4,024 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,670 |
1,404 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,470 |
1,345 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,533 |
1,404 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
234 |
179 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
425 |
379 |
$9K |
| D1206 |
Topical application of fluoride varnish |
540 |
483 |
$8K |
| D0330 |
Panoramic radiographic image |
186 |
175 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
13 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
13 |
$1K |