| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
872 |
790 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,226 |
1,122 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,151 |
1,053 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
925 |
844 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
181 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
50 |
$1K |
| D2140 |
|
21 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$433.20 |