| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
810 |
776 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,332 |
1,309 |
$39K |
| D1120 |
Prophylaxis - child |
642 |
626 |
$25K |
| D0274 |
Bitewings - four radiographic images |
619 |
606 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
899 |
869 |
$22K |
| D1206 |
Topical application of fluoride varnish |
652 |
638 |
$17K |
| D0330 |
Panoramic radiographic image |
88 |
84 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
108 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
73 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
16 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
50 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$393.65 |