| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,278 |
353 |
$119K |
| D1120 |
Prophylaxis - child |
536 |
506 |
$15K |
| D1206 |
Topical application of fluoride varnish |
653 |
628 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
430 |
426 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
211 |
200 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$744.36 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$466.93 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
14 |
$391.04 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$184.20 |