| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
852 |
842 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
214 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
443 |
37 |
$11K |
| D0330 |
Panoramic radiographic image |
140 |
135 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
702 |
693 |
$9K |
| D1206 |
Topical application of fluoride varnish |
815 |
805 |
$4K |
| D1999 |
|
13 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
30 |
$2K |
| D1330 |
|
1,012 |
996 |
$2K |
| D0274 |
Bitewings - four radiographic images |
45 |
45 |
$591.68 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$261.24 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$171.48 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |
| D0180 |
|
52 |
52 |
$0.00 |
| D0350 |
|
15 |
12 |
$0.00 |