| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
841 |
831 |
$22K |
| D1110 |
Prophylaxis - adult |
437 |
430 |
$19K |
| D1120 |
Prophylaxis - child |
526 |
522 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
768 |
760 |
$14K |
| D0272 |
Bitewings - two radiographic images |
453 |
450 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
113 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
16 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$1K |