| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4212 |
|
51 |
43 |
$14K |
| D1110 |
Prophylaxis - adult |
396 |
379 |
$11K |
| D9920 |
|
468 |
353 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
493 |
403 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
364 |
349 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
199 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
308 |
290 |
$4K |
| D2931 |
|
28 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
284 |
$2K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$2K |