| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
757 |
753 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
798 |
$20K |
| D1206 |
Topical application of fluoride varnish |
785 |
784 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
189 |
$8K |
| D0272 |
Bitewings - two radiographic images |
334 |
331 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
173 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
54 |
$4K |
| D1110 |
Prophylaxis - adult |
91 |
91 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
155 |
$3K |
| D1330 |
|
516 |
508 |
$2K |
| D0603 |
|
205 |
202 |
$2K |
| D0602 |
|
114 |
114 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$486.55 |