| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,090 |
1,088 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,013 |
1,012 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,736 |
1,243 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
387 |
203 |
$22K |
| D1351 |
Sealant - per tooth |
1,009 |
340 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
314 |
188 |
$21K |
| D2140 |
|
279 |
181 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
339 |
306 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,023 |
1,021 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
217 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,161 |
1,159 |
$10K |
| D1110 |
Prophylaxis - adult |
125 |
125 |
$8K |
| D0350 |
|
422 |
229 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
257 |
$3K |
| D0274 |
Bitewings - four radiographic images |
46 |
46 |
$993.60 |
| D9430 |
|
15 |
15 |
$392.00 |