| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,409 |
1,315 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,703 |
1,598 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,671 |
1,564 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
598 |
582 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
250 |
221 |
$7K |
| D0272 |
Bitewings - two radiographic images |
270 |
242 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$514.50 |