| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
399 |
394 |
$13K |
| D1206 |
Topical application of fluoride varnish |
476 |
471 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
376 |
370 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
132 |
120 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
126 |
124 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
15 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$2K |
| D1110 |
Prophylaxis - adult |
34 |
34 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
34 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$324.22 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$297.96 |
| D0240 |
|
18 |
12 |
$220.86 |