| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
806 |
746 |
$34K |
| D1206 |
Topical application of fluoride varnish |
958 |
875 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
699 |
654 |
$16K |
| D0272 |
Bitewings - two radiographic images |
370 |
352 |
$8K |
| D1120 |
Prophylaxis - child |
118 |
114 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
117 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
84 |
84 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$345.80 |