| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
607 |
581 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
457 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
438 |
420 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
130 |
$8K |
| D0272 |
Bitewings - two radiographic images |
258 |
248 |
$8K |
| D1206 |
Topical application of fluoride varnish |
220 |
207 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
175 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
52 |
$2K |
| D0274 |
Bitewings - four radiographic images |
49 |
44 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
90 |
$1K |
| D0330 |
Panoramic radiographic image |
16 |
12 |
$739.96 |