| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
490 |
459 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
425 |
396 |
$10K |
| D1206 |
Topical application of fluoride varnish |
558 |
525 |
$7K |
| D0272 |
Bitewings - two radiographic images |
467 |
438 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
65 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
99 |
77 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
110 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$693.87 |