| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
583 |
583 |
$28K |
| D0330 |
Panoramic radiographic image |
299 |
299 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
634 |
633 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
303 |
$14K |
| D0272 |
Bitewings - two radiographic images |
584 |
582 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
317 |
250 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
538 |
$11K |
| D1120 |
Prophylaxis - child |
260 |
260 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
31 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
117 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$1K |