| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
757 |
716 |
$19K |
| D1110 |
Prophylaxis - adult |
356 |
342 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
408 |
397 |
$8K |
| D0272 |
Bitewings - two radiographic images |
304 |
282 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
127 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$469.30 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$300.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$259.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$185.25 |