| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
398 |
394 |
$14K |
| D1206 |
Topical application of fluoride varnish |
448 |
447 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
337 |
336 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
70 |
$4K |
| D0274 |
Bitewings - four radiographic images |
79 |
79 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
35 |
$1K |
| D0240 |
|
55 |
26 |
$744.00 |
| D0350 |
|
20 |
17 |
$0.00 |
| D0603 |
|
48 |
43 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
18 |
$0.00 |