| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,005 |
989 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,487 |
1,444 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,114 |
1,099 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
135 |
124 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
310 |
303 |
$6K |
| D1120 |
Prophylaxis - child |
166 |
160 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
59 |
39 |
$4K |
| D1351 |
Sealant - per tooth |
73 |
18 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
44 |
38 |
$751.36 |
| D1206 |
Topical application of fluoride varnish |
18 |
17 |
$319.20 |