| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,390 |
1,081 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,969 |
1,944 |
$38K |
| D1110 |
Prophylaxis - adult |
891 |
881 |
$37K |
| D2140 |
|
427 |
243 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,020 |
1,011 |
$24K |
| D1120 |
Prophylaxis - child |
533 |
525 |
$17K |
| D0330 |
Panoramic radiographic image |
279 |
278 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
113 |
$12K |
| D0274 |
Bitewings - four radiographic images |
181 |
178 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
145 |
$4K |
| D0272 |
Bitewings - two radiographic images |
213 |
213 |
$4K |