| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,694 |
2,619 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
2,515 |
2,440 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,649 |
2,575 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
381 |
320 |
$20K |
| D0272 |
Bitewings - two radiographic images |
609 |
596 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
38 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$3K |