| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
326 |
302 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
550 |
507 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
479 |
450 |
$9K |
| D0272 |
Bitewings - two radiographic images |
387 |
358 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
117 |
$4K |
| D1120 |
Prophylaxis - child |
52 |
52 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
72 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
39 |
$821.20 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$261.70 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$205.20 |