| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
499 |
445 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
178 |
115 |
$11K |
| D0274 |
Bitewings - four radiographic images |
421 |
386 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
576 |
522 |
$7K |
| D1110 |
Prophylaxis - adult |
313 |
280 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
894 |
535 |
$5K |
| D1120 |
Prophylaxis - child |
96 |
91 |
$4K |
| D9248 |
|
75 |
74 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
95 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
72 |
57 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
89 |
$901.12 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
40 |
$516.32 |
| D7311 |
|
25 |
15 |
$80.00 |
| D4355 |
|
17 |
16 |
$70.00 |
| D7510 |
|
17 |
15 |
$0.00 |