| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,100 |
2,973 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,571 |
3,434 |
$82K |
| D0272 |
Bitewings - two radiographic images |
3,117 |
2,998 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,161 |
3,042 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
708 |
637 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
89 |
$13K |
| D0330 |
Panoramic radiographic image |
157 |
145 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
65 |
$8K |
| D1110 |
Prophylaxis - adult |
57 |
57 |
$3K |
| D1206 |
Topical application of fluoride varnish |
82 |
72 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
126 |
$2K |