| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
2,655 |
1,409 |
$62K |
| D1110 |
Prophylaxis - adult |
1,166 |
1,146 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,964 |
1,931 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,621 |
1,598 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,961 |
1,932 |
$37K |
| D1120 |
Prophylaxis - child |
937 |
923 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
523 |
469 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
203 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
36 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$912.00 |