| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,386 |
2,289 |
$130K |
| D0120 |
Periodic oral evaluation - established patient |
2,036 |
1,939 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,249 |
1,189 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,373 |
1,316 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,261 |
1,194 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
693 |
661 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
105 |
57 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
281 |
264 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
708 |
666 |
$8K |
| D1110 |
Prophylaxis - adult |
113 |
107 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
122 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$824.10 |