| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
498 |
498 |
$21K |
| D1206 |
Topical application of fluoride varnish |
309 |
309 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
302 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
138 |
138 |
$4K |
| D0272 |
Bitewings - two radiographic images |
227 |
227 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
228 |
228 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
28 |
$840.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
28 |
$810.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$171.08 |