| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
546 |
540 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
614 |
609 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
450 |
438 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
597 |
594 |
$15K |
| D0272 |
Bitewings - two radiographic images |
500 |
495 |
$13K |
| D1120 |
Prophylaxis - child |
243 |
240 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$9K |
| D2950 |
|
47 |
40 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
298 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
25 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
68 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
133 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$2K |