| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
648 |
504 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
649 |
501 |
$12K |
| D1110 |
Prophylaxis - adult |
277 |
216 |
$12K |
| D0272 |
Bitewings - two radiographic images |
192 |
124 |
$4K |
| D1120 |
Prophylaxis - child |
111 |
87 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
14 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
15 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
13 |
$588.40 |