| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,976 |
1,947 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
830 |
816 |
$57K |
| D1310 |
|
1,361 |
1,341 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,917 |
1,886 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
380 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
222 |
221 |
$16K |
| D0350 |
|
1,201 |
442 |
$10K |
| D0603 |
|
611 |
604 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
172 |
169 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,414 |
367 |
$5K |
| D0602 |
|
249 |
237 |
$4K |
| D0240 |
|
345 |
199 |
$3K |
| D0601 |
|
145 |
144 |
$2K |
| D0272 |
Bitewings - two radiographic images |
176 |
176 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$390.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$204.00 |
| D1330 |
|
144 |
144 |
$0.00 |