| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,388 |
1,104 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,093 |
879 |
$21K |
| D1110 |
Prophylaxis - adult |
448 |
333 |
$20K |
| D0272 |
Bitewings - two radiographic images |
714 |
604 |
$16K |
| D1120 |
Prophylaxis - child |
397 |
336 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
172 |
146 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
38 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
46 |
$593.36 |