| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
800 |
776 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
856 |
823 |
$18K |
| D1206 |
Topical application of fluoride varnish |
885 |
858 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
53 |
18 |
$7K |
| D0272 |
Bitewings - two radiographic images |
308 |
302 |
$6K |
| D1110 |
Prophylaxis - adult |
103 |
96 |
$4K |
| D0330 |
Panoramic radiographic image |
58 |
55 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
83 |
$3K |
| D9920 |
|
42 |
38 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$2K |
| D1330 |
|
626 |
617 |
$0.00 |
| D1310 |
|
626 |
617 |
$0.00 |