| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
834 |
802 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,117 |
1,082 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
736 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
552 |
420 |
$16K |
| D0274 |
Bitewings - four radiographic images |
538 |
529 |
$13K |
| D0330 |
Panoramic radiographic image |
182 |
167 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
190 |
$5K |
| D2140 |
|
59 |
39 |
$4K |
| D1120 |
Prophylaxis - child |
110 |
102 |
$3K |
| D0272 |
Bitewings - two radiographic images |
176 |
157 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
38 |
$443.80 |