| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,763 |
3,703 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
5,003 |
4,913 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,972 |
4,881 |
$98K |
| D1110 |
Prophylaxis - adult |
1,423 |
1,390 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,473 |
2,423 |
$43K |
| D0330 |
Panoramic radiographic image |
678 |
671 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
363 |
149 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
584 |
554 |
$16K |