| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,673 |
1,613 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,350 |
2,263 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,679 |
1,608 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,032 |
994 |
$22K |
| D1120 |
Prophylaxis - child |
367 |
344 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
31 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
83 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
219 |
189 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
291 |
277 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
136 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
57 |
$2K |
| D0274 |
Bitewings - four radiographic images |
117 |
114 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$564.30 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$468.80 |
| D1999 |
|
13 |
13 |
$0.00 |