| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
405 |
405 |
$13K |
| D1206 |
Topical application of fluoride varnish |
653 |
652 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
501 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
31 |
$7K |
| D0272 |
Bitewings - two radiographic images |
209 |
209 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
68 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
80 |
$2K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$1K |
| D1351 |
Sealant - per tooth |
42 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$573.21 |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
68 |
$558.86 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$247.20 |