| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
426 |
133 |
$29K |
| D1110 |
Prophylaxis - adult |
624 |
540 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
833 |
713 |
$22K |
| D0272 |
Bitewings - two radiographic images |
764 |
652 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
349 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
534 |
439 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
453 |
362 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
26 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$423.20 |