| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
854 |
831 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
729 |
709 |
$24K |
| D1206 |
Topical application of fluoride varnish |
877 |
854 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
194 |
$14K |
| D0272 |
Bitewings - two radiographic images |
232 |
228 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
12 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
63 |
$4K |
| D9310 |
|
26 |
25 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$689.53 |