| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
498 |
477 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
745 |
700 |
$10K |
| D1354 |
|
348 |
85 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
239 |
232 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
324 |
313 |
$6K |
| D0272 |
Bitewings - two radiographic images |
360 |
336 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
184 |
164 |
$5K |
| D1999 |
|
219 |
181 |
$4K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$463.05 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$334.95 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
12 |
$92.40 |