| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
484 |
444 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
548 |
508 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
589 |
541 |
$8K |
| D0272 |
Bitewings - two radiographic images |
317 |
299 |
$5K |
| D1110 |
Prophylaxis - adult |
149 |
133 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
39 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
171 |
141 |
$3K |
| D0274 |
Bitewings - four radiographic images |
163 |
130 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
67 |
$1K |
| D0330 |
Panoramic radiographic image |
21 |
17 |
$735.00 |