| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
290 |
233 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
450 |
355 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
286 |
208 |
$4K |
| D0272 |
Bitewings - two radiographic images |
205 |
169 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
82 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
24 |
$665.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$252.70 |