| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
76 |
$10K |
| D1110 |
Prophylaxis - adult |
150 |
139 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
271 |
249 |
$6K |
| D0272 |
Bitewings - two radiographic images |
243 |
227 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
203 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
248 |
222 |
$4K |
| D1120 |
Prophylaxis - child |
100 |
94 |
$3K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
189 |
168 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
28 |
$923.40 |