| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,235 |
1,208 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,266 |
2,206 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,806 |
1,752 |
$26K |
| D1120 |
Prophylaxis - child |
721 |
689 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
862 |
730 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
102 |
$11K |
| D0274 |
Bitewings - four radiographic images |
406 |
399 |
$9K |
| D0272 |
Bitewings - two radiographic images |
355 |
346 |
$6K |
| D1999 |
|
313 |
239 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
58 |
51 |
$3K |
| D1206 |
Topical application of fluoride varnish |
54 |
53 |
$2K |