| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,509 |
1,367 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,099 |
1,926 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,038 |
1,866 |
$27K |
| D1110 |
Prophylaxis - adult |
683 |
637 |
$23K |
| D0272 |
Bitewings - two radiographic images |
533 |
487 |
$8K |
| D1206 |
Topical application of fluoride varnish |
360 |
339 |
$6K |
| D0330 |
Panoramic radiographic image |
143 |
132 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
295 |
250 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
38 |
$5K |
| D0274 |
Bitewings - four radiographic images |
205 |
187 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
41 |
$924.00 |