| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,522 |
2,522 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,922 |
3,920 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,538 |
3,537 |
$60K |
| D1110 |
Prophylaxis - adult |
1,273 |
1,271 |
$46K |
| D0272 |
Bitewings - two radiographic images |
505 |
505 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
284 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
165 |
$5K |
| D0274 |
Bitewings - four radiographic images |
178 |
178 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$0.00 |