| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
535 |
455 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
905 |
755 |
$23K |
| D0272 |
Bitewings - two radiographic images |
752 |
642 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
674 |
568 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
251 |
$6K |
| D1120 |
Prophylaxis - child |
129 |
100 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
139 |
116 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
88 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D2140 |
|
13 |
12 |
$815.17 |