| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
717 |
618 |
$19K |
| D1110 |
Prophylaxis - adult |
151 |
122 |
$7K |
| D0272 |
Bitewings - two radiographic images |
249 |
210 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
329 |
274 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
240 |
209 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
55 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
95 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
50 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$469.30 |