| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
744 |
743 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
368 |
368 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
355 |
355 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
245 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
73 |
$3K |
| D0272 |
Bitewings - two radiographic images |
112 |
112 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
290 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
456 |
197 |
$1K |
| D1206 |
Topical application of fluoride varnish |
443 |
441 |
$1K |
| D9920 |
|
185 |
167 |
$890.50 |
| D9994 |
|
403 |
376 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
14 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
40 |
$0.00 |
| D3120 |
|
35 |
13 |
$0.00 |
| D9310 |
|
15 |
15 |
$0.00 |