| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
251 |
250 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
47 |
47 |
$7K |
| D1120 |
Prophylaxis - child |
176 |
175 |
$6K |
| D1110 |
Prophylaxis - adult |
88 |
88 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
281 |
280 |
$4K |
| D0272 |
Bitewings - two radiographic images |
145 |
145 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
199 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
84 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
193 |
189 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
31 |
$894.63 |
| D0603 |
|
409 |
408 |
$0.00 |