| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
547 |
546 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
534 |
533 |
$15K |
| D1206 |
Topical application of fluoride varnish |
284 |
284 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
256 |
256 |
$2K |
| D9310 |
|
27 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$939.26 |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$837.20 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$815.36 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
63 |
$622.44 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$259.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$94.64 |