| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,820 |
1,545 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,809 |
1,525 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
198 |
132 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
229 |
$4K |
| D1206 |
Topical application of fluoride varnish |
256 |
207 |
$3K |
| D0272 |
Bitewings - two radiographic images |
112 |
95 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
25 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
184 |
145 |
$844.19 |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
65 |
$570.14 |
| D1999 |
|
253 |
233 |
$0.00 |