| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
473 |
465 |
$11K |
| D1110 |
Prophylaxis - adult |
244 |
240 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
455 |
452 |
$9K |
| D1120 |
Prophylaxis - child |
225 |
220 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
168 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$5K |
| D0272 |
Bitewings - two radiographic images |
264 |
262 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
28 |
$4K |