| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,099 |
1,058 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
271 |
266 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
947 |
912 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,187 |
1,133 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,079 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,190 |
870 |
$12K |
| D0272 |
Bitewings - two radiographic images |
449 |
432 |
$10K |
| D0350 |
|
350 |
263 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
69 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
82 |
$2K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$713.44 |
| D0602 |
|
1,683 |
1,638 |
$0.00 |