| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,079 |
2,065 |
$54K |
| D1110 |
Prophylaxis - adult |
1,203 |
1,185 |
$53K |
| D1120 |
Prophylaxis - child |
1,464 |
1,456 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,370 |
1,362 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,096 |
1,086 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
573 |
507 |
$20K |
| D0330 |
Panoramic radiographic image |
272 |
272 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
281 |
$13K |
| D1206 |
Topical application of fluoride varnish |
269 |
265 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
198 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$501.88 |