| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
82 |
82 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
37 |
$2K |
| D1206 |
Topical application of fluoride varnish |
89 |
89 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$805.35 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$494.13 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$404.46 |
| D0272 |
Bitewings - two radiographic images |
19 |
19 |
$328.95 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$323.52 |