| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
341 |
280 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
303 |
232 |
$6K |
| D0330 |
Panoramic radiographic image |
81 |
67 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
52 |
52 |
$1K |
| D1206 |
Topical application of fluoride varnish |
45 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
27 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
37 |
$433.09 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
14 |
$157.86 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
40 |
$147.48 |