| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,844 |
2,729 |
$54K |
| D1110 |
Prophylaxis - adult |
1,162 |
1,123 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,559 |
2,443 |
$36K |
| D1120 |
Prophylaxis - child |
1,259 |
1,192 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,439 |
1,310 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
365 |
252 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
226 |
$18K |
| D0272 |
Bitewings - two radiographic images |
452 |
427 |
$7K |
| D0274 |
Bitewings - four radiographic images |
307 |
295 |
$7K |
| D0330 |
Panoramic radiographic image |
44 |
43 |
$2K |