| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
581 |
578 |
$18K |
| D1206 |
Topical application of fluoride varnish |
945 |
943 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
664 |
663 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
114 |
$5K |
| D0272 |
Bitewings - two radiographic images |
315 |
315 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
25 |
$4K |
| D1110 |
Prophylaxis - adult |
84 |
84 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
131 |
131 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
78 |
$2K |
| D1351 |
Sealant - per tooth |
45 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
130 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$957.19 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$248.42 |
| D1354 |
|
13 |
13 |
$183.95 |