| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,859 |
2,371 |
$72K |
| D1110 |
Prophylaxis - adult |
927 |
753 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,084 |
968 |
$20K |
| D0272 |
Bitewings - two radiographic images |
749 |
588 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
814 |
612 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
886 |
623 |
$15K |
| D1120 |
Prophylaxis - child |
259 |
180 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
169 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
37 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
145 |
78 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
50 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$746.05 |