| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
266 |
94 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,055 |
1,623 |
$89K |
| D0460 |
|
2,420 |
1,870 |
$66K |
| D1110 |
Prophylaxis - adult |
703 |
689 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,039 |
889 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
853 |
805 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
244 |
$17K |
| D0330 |
Panoramic radiographic image |
254 |
250 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
472 |
460 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
52 |
$13K |
| D9951 |
|
145 |
115 |
$12K |
| D3110 |
|
294 |
131 |
$10K |
| D7510 |
|
48 |
28 |
$6K |
| D9110 |
|
100 |
72 |
$6K |
| D9952 |
|
13 |
13 |
$5K |
| D7910 |
|
15 |
14 |
$2K |
| D0190 |
|
63 |
49 |
$2K |
| D9430 |
|
12 |
12 |
$648.00 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
27 |
$481.60 |
| D9996 |
|
88 |
63 |
$0.00 |