| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
695 |
685 |
$14K |
| D1120 |
Prophylaxis - child |
487 |
487 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
367 |
366 |
$7K |
| D1110 |
Prophylaxis - adult |
139 |
137 |
$6K |
| D0272 |
Bitewings - two radiographic images |
298 |
294 |
$5K |
| D9920 |
|
59 |
57 |
$4K |
| D1206 |
Topical application of fluoride varnish |
186 |
182 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
55 |
53 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D1330 |
|
287 |
286 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
58 |
$1K |
| D1354 |
|
59 |
25 |
$460.00 |
| D0240 |
|
32 |
31 |
$421.46 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$417.69 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
43 |
$363.68 |
| D1310 |
|
13 |
12 |
$60.00 |