| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,244 |
1,244 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,367 |
1,367 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,783 |
1,782 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
567 |
530 |
$18K |
| D0272 |
Bitewings - two radiographic images |
995 |
994 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
80 |
$3K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D0240 |
|
42 |
26 |
$766.72 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$567.00 |