| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
770 |
723 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
210 |
$8K |
| D1206 |
Topical application of fluoride varnish |
805 |
756 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
327 |
315 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
210 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$824.89 |
| D0140 |
Limited oral evaluation - problem focused |
60 |
58 |
$650.00 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$342.90 |
| D1354 |
|
49 |
12 |
$156.86 |
| D1330 |
|
30 |
29 |
$0.00 |