| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,121 |
1,061 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,418 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,436 |
1,364 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,027 |
894 |
$24K |
| D9920 |
|
163 |
127 |
$5K |
| D0272 |
Bitewings - two radiographic images |
177 |
170 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
307 |
272 |
$2K |
| D1110 |
Prophylaxis - adult |
34 |
32 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
180 |
100 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$386.17 |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
72 |
$44.78 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$0.00 |