| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
906 |
774 |
$30K |
| D1110 |
Prophylaxis - adult |
797 |
766 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,840 |
1,612 |
$26K |
| D0330 |
Panoramic radiographic image |
417 |
393 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
500 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,868 |
1,152 |
$21K |
| D0274 |
Bitewings - four radiographic images |
649 |
622 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
534 |
517 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
25 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
287 |
280 |
$4K |
| D7311 |
|
69 |
42 |
$4K |
| D9110 |
|
54 |
49 |
$2K |
| D2160 |
|
15 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
59 |
58 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$568.90 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$246.26 |