| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,014 |
1,655 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
957 |
862 |
$43K |
| D1110 |
Prophylaxis - adult |
560 |
547 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,011 |
1,000 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,173 |
1,158 |
$22K |
| D0272 |
Bitewings - two radiographic images |
436 |
434 |
$11K |
| D1120 |
Prophylaxis - child |
198 |
198 |
$8K |
| D0274 |
Bitewings - four radiographic images |
207 |
203 |
$8K |
| D9440 |
|
419 |
347 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
38 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
499 |
464 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
55 |
$3K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
27 |
$1K |