| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
854 |
774 |
$14K |
| D1110 |
Prophylaxis - adult |
346 |
325 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
538 |
493 |
$7K |
| D1120 |
Prophylaxis - child |
292 |
260 |
$7K |
| D0274 |
Bitewings - four radiographic images |
132 |
116 |
$3K |
| D1206 |
Topical application of fluoride varnish |
107 |
102 |
$1K |
| D0330 |
Panoramic radiographic image |
30 |
26 |
$1K |
| D0272 |
Bitewings - two radiographic images |
55 |
53 |
$918.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
30 |
$600.00 |
| D1999 |
|
24 |
17 |
$360.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$319.00 |