| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,914 |
2,864 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
3,767 |
3,693 |
$96K |
| D0330 |
Panoramic radiographic image |
1,198 |
1,169 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,415 |
1,384 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
806 |
$33K |
| D4346 |
|
455 |
424 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
306 |
119 |
$29K |
| D1206 |
Topical application of fluoride varnish |
777 |
759 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
376 |
369 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
76 |
$11K |
| D1120 |
Prophylaxis - child |
270 |
266 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
41 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
546 |
528 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
297 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
16 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$419.56 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$265.46 |