| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
948 |
911 |
$17K |
| D1120 |
Prophylaxis - child |
621 |
591 |
$16K |
| D1110 |
Prophylaxis - adult |
443 |
425 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
969 |
910 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
624 |
503 |
$10K |
| D0272 |
Bitewings - two radiographic images |
574 |
540 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
15 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$371.00 |