| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,327 |
2,290 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,529 |
2,505 |
$78K |
| D1206 |
Topical application of fluoride varnish |
1,697 |
1,674 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
776 |
731 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,112 |
1,095 |
$20K |
| D0272 |
Bitewings - two radiographic images |
627 |
615 |
$16K |
| D1110 |
Prophylaxis - adult |
144 |
139 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
40 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
46 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$408.12 |