| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,292 |
$30K |
| D1110 |
Prophylaxis - adult |
655 |
624 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,234 |
1,182 |
$24K |
| D1120 |
Prophylaxis - child |
721 |
697 |
$22K |
| D0274 |
Bitewings - four radiographic images |
584 |
561 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
239 |
217 |
$6K |
| D0330 |
Panoramic radiographic image |
179 |
172 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
187 |
180 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
71 |
$764.89 |