| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,949 |
2,939 |
$164K |
| D1120 |
Prophylaxis - child |
2,898 |
2,888 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,133 |
3,407 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,862 |
2,849 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,498 |
2,485 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
178 |
178 |
$11K |
| D0274 |
Bitewings - four radiographic images |
370 |
370 |
$8K |
| D1110 |
Prophylaxis - adult |
50 |
50 |
$4K |
| D1310 |
|
105 |
105 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
53 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |
| D2140 |
|
19 |
13 |
$1K |
| D0601 |
|
82 |
82 |
$840.00 |
| D9993 |
|
37 |
37 |
$390.00 |