| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
751 |
736 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
981 |
957 |
$25K |
| D1206 |
Topical application of fluoride varnish |
991 |
968 |
$21K |
| D1110 |
Prophylaxis - adult |
227 |
219 |
$10K |
| D0272 |
Bitewings - two radiographic images |
229 |
226 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
180 |
$3K |
| D0274 |
Bitewings - four radiographic images |
50 |
45 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
150 |
145 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$259.83 |