| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
131 |
124 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
171 |
$4K |
| D1110 |
Prophylaxis - adult |
117 |
112 |
$4K |
| D1206 |
Topical application of fluoride varnish |
185 |
179 |
$3K |
| D0274 |
Bitewings - four radiographic images |
80 |
78 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
42 |
41 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
56 |
55 |
$869.63 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$524.12 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
14 |
$452.48 |