| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,846 |
2,846 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
3,528 |
3,528 |
$97K |
| D1206 |
Topical application of fluoride varnish |
2,975 |
2,974 |
$84K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
498 |
472 |
$75K |
| D1110 |
Prophylaxis - adult |
695 |
695 |
$37K |
| D0274 |
Bitewings - four radiographic images |
865 |
865 |
$33K |
| D1354 |
|
806 |
340 |
$30K |
| D1351 |
Sealant - per tooth |
409 |
102 |
$15K |
| D0330 |
Panoramic radiographic image |
209 |
209 |
$11K |
| D0272 |
Bitewings - two radiographic images |
491 |
491 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
522 |
522 |
$7K |