| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,949 |
1,805 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,597 |
1,464 |
$21K |
| D1120 |
Prophylaxis - child |
794 |
715 |
$19K |
| D1110 |
Prophylaxis - adult |
455 |
427 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
296 |
231 |
$5K |
| D0272 |
Bitewings - two radiographic images |
276 |
244 |
$4K |
| D0274 |
Bitewings - four radiographic images |
176 |
165 |
$3K |
| D1206 |
Topical application of fluoride varnish |
77 |
73 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
28 |
$1K |
| D0330 |
Panoramic radiographic image |
54 |
36 |
$1K |