| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,285 |
1,272 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,299 |
2,270 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,802 |
1,781 |
$33K |
| D1120 |
Prophylaxis - child |
926 |
925 |
$26K |
| D0274 |
Bitewings - four radiographic images |
919 |
909 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
567 |
547 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
88 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
607 |
593 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
27 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
200 |
187 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
123 |
$4K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$1K |