| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,008 |
1,981 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,033 |
1,989 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,463 |
1,424 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,237 |
1,212 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
877 |
866 |
$16K |
| D1110 |
Prophylaxis - adult |
288 |
282 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
236 |
231 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
332 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
40 |
$4K |
| D1330 |
|
725 |
722 |
$3K |
| D1354 |
|
396 |
180 |
$3K |
| D0240 |
|
264 |
241 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
292 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
114 |
113 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$2K |