| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
331 |
219 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
596 |
411 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
280 |
$7K |
| D1120 |
Prophylaxis - child |
251 |
157 |
$5K |
| D0272 |
Bitewings - two radiographic images |
459 |
309 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
24 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
93 |
57 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
62 |
42 |
$2K |
| D0330 |
Panoramic radiographic image |
22 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$535.50 |