| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,212 |
2,212 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,909 |
1,909 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,767 |
2,767 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
676 |
667 |
$21K |
| D1110 |
Prophylaxis - adult |
413 |
413 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
381 |
$15K |
| D0272 |
Bitewings - two radiographic images |
583 |
583 |
$11K |
| D0240 |
|
333 |
177 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
32 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
69 |
$941.50 |