| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,884 |
1,587 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,827 |
1,767 |
$25K |
| D1110 |
Prophylaxis - adult |
667 |
636 |
$23K |
| D1120 |
Prophylaxis - child |
811 |
792 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
746 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
599 |
511 |
$11K |
| D0272 |
Bitewings - two radiographic images |
259 |
252 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
184 |
$4K |
| D0274 |
Bitewings - four radiographic images |
145 |
141 |
$3K |
| D0330 |
Panoramic radiographic image |
70 |
66 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
16 |
$2K |