| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,432 |
2,508 |
$53K |
| D1120 |
Prophylaxis - child |
3,446 |
2,507 |
$41K |
| D1206 |
Topical application of fluoride varnish |
3,200 |
2,330 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,193 |
807 |
$23K |
| D0330 |
Panoramic radiographic image |
1,170 |
736 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,636 |
1,159 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
402 |
161 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
666 |
345 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
14 |
$186.00 |
| D1203 |
|
21 |
21 |
$0.00 |