| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
625 |
551 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
508 |
451 |
$12K |
| D1206 |
Topical application of fluoride varnish |
702 |
629 |
$9K |
| D0272 |
Bitewings - two radiographic images |
554 |
492 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
131 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
147 |
131 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
145 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$690.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
22 |
13 |
$629.00 |