| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
605 |
562 |
$15K |
| D1120 |
Prophylaxis - child |
409 |
384 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
496 |
458 |
$9K |
| D0272 |
Bitewings - two radiographic images |
319 |
294 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
15 |
$5K |
| D1110 |
Prophylaxis - adult |
66 |
53 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
118 |
112 |
$3K |
| D0603 |
|
294 |
267 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
30 |
$475.40 |
| D0602 |
|
68 |
60 |
$310.65 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$171.00 |