| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
912 |
878 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,652 |
1,586 |
$35K |
| D1120 |
Prophylaxis - child |
967 |
935 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,466 |
1,426 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
121 |
56 |
$14K |
| D0274 |
Bitewings - four radiographic images |
446 |
440 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
811 |
785 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
276 |
242 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
923 |
578 |
$7K |
| D1206 |
Topical application of fluoride varnish |
263 |
248 |
$5K |
| D9610 |
|
101 |
96 |
$3K |
| D0350 |
|
61 |
61 |
$2K |
| D0272 |
Bitewings - two radiographic images |
99 |
99 |
$2K |