| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,193 |
2,193 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
900 |
900 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
706 |
706 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,961 |
1,961 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
256 |
116 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,278 |
2,017 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
278 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
580 |
549 |
$23K |
| D0330 |
Panoramic radiographic image |
481 |
481 |
$16K |
| D9430 |
|
400 |
400 |
$13K |
| D0274 |
Bitewings - four radiographic images |
521 |
521 |
$11K |
| D0272 |
Bitewings - two radiographic images |
445 |
445 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
59 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
305 |
300 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$1K |
| D1352 |
|
27 |
15 |
$1K |
| D0470 |
|
38 |
38 |
$75.00 |