| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
856 |
856 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
869 |
869 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
453 |
453 |
$11K |
| D1206 |
Topical application of fluoride varnish |
246 |
246 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
194 |
186 |
$5K |
| D0603 |
|
442 |
441 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
381 |
381 |
$2K |
| D0272 |
Bitewings - two radiographic images |
165 |
165 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
237 |
236 |
$1K |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$600.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
15 |
$476.00 |