| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,656 |
1,235 |
$207K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,183 |
1,805 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,504 |
2,024 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
2,922 |
2,396 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
799 |
736 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
466 |
430 |
$12K |
| D0272 |
Bitewings - two radiographic images |
414 |
385 |
$11K |
| D1120 |
Prophylaxis - child |
256 |
229 |
$9K |
| D1110 |
Prophylaxis - adult |
90 |
90 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
320 |
272 |
$4K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22 |
22 |
$680.00 |