| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
623 |
542 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
755 |
649 |
$16K |
| D1110 |
Prophylaxis - adult |
341 |
294 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
917 |
803 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
41 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
39 |
$3K |
| D0274 |
Bitewings - four radiographic images |
111 |
79 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
44 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
14 |
$459.16 |
| D0602 |
|
291 |
272 |
$0.00 |
| D0603 |
|
634 |
580 |
$0.00 |