| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
584 |
572 |
$26K |
| D1206 |
Topical application of fluoride varnish |
697 |
684 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
428 |
420 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
114 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
26 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
80 |
$2K |
| D1330 |
|
217 |
212 |
$1K |
| D0272 |
Bitewings - two radiographic images |
44 |
44 |
$684.48 |