| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
1,687 |
1,461 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,844 |
1,732 |
$24K |
| D1120 |
Prophylaxis - child |
845 |
794 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,188 |
1,133 |
$21K |
| D1110 |
Prophylaxis - adult |
553 |
487 |
$17K |
| D0330 |
Panoramic radiographic image |
309 |
260 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
385 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
61 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
290 |
$5K |
| D0274 |
Bitewings - four radiographic images |
204 |
186 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
57 |
$2K |