| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,389 |
2,389 |
$119K |
| D0330 |
Panoramic radiographic image |
1,148 |
1,147 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,258 |
1,250 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,214 |
2,214 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,324 |
2,324 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
415 |
252 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
732 |
732 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,742 |
1,742 |
$28K |
| D1120 |
Prophylaxis - child |
400 |
400 |
$14K |
| D0274 |
Bitewings - four radiographic images |
335 |
335 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
688 |
677 |
$9K |
| D2160 |
|
79 |
71 |
$7K |
| D2140 |
|
69 |
50 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
39 |
$4K |
| D2161 |
|
13 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$390.00 |