| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
316 |
$13K |
| D1120 |
Prophylaxis - child |
219 |
219 |
$8K |
| D0330 |
Panoramic radiographic image |
143 |
143 |
$6K |
| D1110 |
Prophylaxis - adult |
92 |
92 |
$5K |
| D1206 |
Topical application of fluoride varnish |
270 |
270 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
103 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
24 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
94 |
$3K |
| D0274 |
Bitewings - four radiographic images |
94 |
94 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$303.04 |