| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
312 |
297 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
603 |
581 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
444 |
426 |
$6K |
| D0274 |
Bitewings - four radiographic images |
141 |
140 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
112 |
$3K |
| D0330 |
Panoramic radiographic image |
65 |
64 |
$2K |
| D1120 |
Prophylaxis - child |
78 |
77 |
$2K |
| D0272 |
Bitewings - two radiographic images |
57 |
57 |
$973.20 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$287.10 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$143.50 |