| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
409 |
348 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
581 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
78 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
373 |
318 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
286 |
210 |
$7K |
| D2140 |
|
73 |
25 |
$5K |
| D0272 |
Bitewings - two radiographic images |
201 |
154 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
68 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
42 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$815.10 |
| D1120 |
Prophylaxis - child |
21 |
12 |
$758.10 |