| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,113 |
2,049 |
$62K |
| D1120 |
Prophylaxis - child |
1,706 |
1,660 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
861 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
94 |
$23K |
| D1110 |
Prophylaxis - adult |
444 |
424 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
223 |
$12K |
| D3120 |
|
250 |
144 |
$9K |
| D0330 |
Panoramic radiographic image |
72 |
72 |
$5K |
| D1354 |
|
163 |
70 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
168 |
$4K |
| D1206 |
Topical application of fluoride varnish |
86 |
78 |
$2K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$1K |
| D0274 |
Bitewings - four radiographic images |
19 |
16 |
$720.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$527.38 |