| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,307 |
1,277 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
755 |
664 |
$20K |
| D1120 |
Prophylaxis - child |
703 |
688 |
$19K |
| D0272 |
Bitewings - two radiographic images |
923 |
900 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
681 |
667 |
$13K |
| D1110 |
Prophylaxis - adult |
200 |
196 |
$6K |
| D1206 |
Topical application of fluoride varnish |
90 |
88 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$710.08 |