| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
715 |
670 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
981 |
939 |
$25K |
| D0272 |
Bitewings - two radiographic images |
923 |
872 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
615 |
559 |
$12K |
| D1206 |
Topical application of fluoride varnish |
481 |
479 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
110 |
46 |
$9K |
| D1120 |
Prophylaxis - child |
210 |
195 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$319.20 |