| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,644 |
3,473 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,414 |
4,221 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,621 |
4,424 |
$79K |
| D0272 |
Bitewings - two radiographic images |
3,033 |
2,866 |
$61K |
| D1110 |
Prophylaxis - adult |
775 |
756 |
$35K |
| D0330 |
Panoramic radiographic image |
429 |
349 |
$21K |
| D0274 |
Bitewings - four radiographic images |
701 |
683 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
533 |
483 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
53 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
25 |
$309.40 |