| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
117 |
117 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
111 |
$3K |
| D1206 |
Topical application of fluoride varnish |
143 |
143 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
62 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
98 |
98 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
98 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$688.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
42 |
$587.31 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$504.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$462.00 |