| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
579 |
564 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
297 |
146 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
619 |
487 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
381 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
327 |
319 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
238 |
236 |
$6K |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
180 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$472.50 |