| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
887 |
307 |
$59K |
| D1110 |
Prophylaxis - adult |
632 |
520 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
907 |
$26K |
| D2140 |
|
449 |
145 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
859 |
725 |
$16K |
| D0272 |
Bitewings - two radiographic images |
589 |
491 |
$13K |
| D0330 |
Panoramic radiographic image |
203 |
158 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
196 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
215 |
109 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
40 |
$2K |
| D1120 |
Prophylaxis - child |
20 |
13 |
$702.00 |