| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,515 |
1,374 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,157 |
2,001 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,685 |
1,554 |
$30K |
| D1999 |
|
1,200 |
923 |
$21K |
| D0272 |
Bitewings - two radiographic images |
623 |
554 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
435 |
362 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
524 |
505 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
269 |
231 |
$7K |
| D1110 |
Prophylaxis - adult |
83 |
83 |
$3K |
| D0330 |
Panoramic radiographic image |
75 |
69 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
24 |
$3K |