| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
497 |
497 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
534 |
534 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
386 |
386 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
145 |
143 |
$4K |
| D0603 |
|
141 |
141 |
$1K |
| D0272 |
Bitewings - two radiographic images |
98 |
98 |
$980.00 |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
150 |
$750.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$406.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
38 |
$129.00 |