| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,217 |
1,370 |
$45K |
| D1120 |
Prophylaxis - child |
2,346 |
1,498 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,908 |
1,068 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,034 |
609 |
$8K |
| D0274 |
Bitewings - four radiographic images |
497 |
322 |
$7K |
| D0330 |
Panoramic radiographic image |
373 |
204 |
$6K |
| D1206 |
Topical application of fluoride varnish |
362 |
330 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
29 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
84 |
$3K |
| D1110 |
Prophylaxis - adult |
360 |
198 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$882.00 |
| D0120 |
Periodic oral evaluation - established patient |
32 |
30 |
$329.56 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
97 |
24 |
$185.72 |