| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,385 |
1,323 |
$29K |
| D1110 |
Prophylaxis - adult |
531 |
508 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,008 |
953 |
$20K |
| D1120 |
Prophylaxis - child |
621 |
607 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
909 |
879 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
782 |
652 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
310 |
299 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
28 |
$5K |
| D0330 |
Panoramic radiographic image |
20 |
16 |
$957.06 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$404.43 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
27 |
$351.54 |