| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,062 |
369 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
575 |
$14K |
| D1110 |
Prophylaxis - adult |
309 |
303 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
351 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
267 |
265 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
137 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
174 |
144 |
$4K |
| D2140 |
|
17 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$771.68 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$433.20 |