| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
295 |
272 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
237 |
218 |
$6K |
| D1206 |
Topical application of fluoride varnish |
313 |
286 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
32 |
$4K |
| D0272 |
Bitewings - two radiographic images |
250 |
229 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
65 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
85 |
77 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
46 |
$550.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$344.29 |