| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,614 |
2,492 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
3,251 |
3,019 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,500 |
3,266 |
$66K |
| D0272 |
Bitewings - two radiographic images |
1,856 |
1,737 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
464 |
181 |
$28K |
| D1120 |
Prophylaxis - child |
412 |
347 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
123 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
512 |
409 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
256 |
$8K |
| D0330 |
Panoramic radiographic image |
216 |
207 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
210 |
$4K |
| D2140 |
|
56 |
26 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$547.20 |