| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
384 |
370 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
597 |
580 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
67 |
$12K |
| D1120 |
Prophylaxis - child |
209 |
203 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
227 |
$4K |
| D0274 |
Bitewings - four radiographic images |
125 |
122 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
106 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
161 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$519.96 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$235.68 |