| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
259 |
249 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
309 |
294 |
$9K |
| D1206 |
Topical application of fluoride varnish |
346 |
332 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
94 |
$8K |
| D0272 |
Bitewings - two radiographic images |
97 |
94 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$982.49 |
| D0274 |
Bitewings - four radiographic images |
24 |
22 |
$789.06 |