| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
938 |
929 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
683 |
683 |
$17K |
| D1206 |
Topical application of fluoride varnish |
724 |
717 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
260 |
254 |
$7K |
| D1110 |
Prophylaxis - adult |
82 |
82 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
83 |
$3K |
| D0272 |
Bitewings - two radiographic images |
147 |
147 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$536.80 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$277.32 |