| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
652 |
569 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
740 |
600 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
969 |
819 |
$19K |
| D0272 |
Bitewings - two radiographic images |
700 |
612 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
126 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
741 |
615 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
466 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
130 |
$6K |
| D2140 |
|
84 |
33 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
142 |
$5K |
| D1120 |
Prophylaxis - child |
113 |
73 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
108 |
$4K |
| D0601 |
|
126 |
121 |
$620.00 |
| D0602 |
|
13 |
13 |
$65.00 |