| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
572 |
565 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
769 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
219 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
819 |
804 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
67 |
$15K |
| D0272 |
Bitewings - two radiographic images |
586 |
576 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
773 |
747 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
871 |
608 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
296 |
280 |
$10K |
| D1120 |
Prophylaxis - child |
253 |
248 |
$9K |
| D0601 |
|
346 |
343 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$689.70 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$229.40 |
| D0602 |
|
18 |
18 |
$90.00 |