| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
571 |
560 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
523 |
510 |
$8K |
| D1110 |
Prophylaxis - adult |
214 |
212 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
265 |
238 |
$5K |
| D0274 |
Bitewings - four radiographic images |
136 |
136 |
$2K |
| D1206 |
Topical application of fluoride varnish |
93 |
88 |
$2K |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$308.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$234.00 |