| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
94 |
88 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
82 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
67 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
40 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
47 |
$696.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
29 |
$676.00 |
| D0272 |
Bitewings - two radiographic images |
76 |
72 |
$658.00 |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
69 |
$375.20 |