| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
981 |
943 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,154 |
1,104 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
807 |
776 |
$20K |
| D2140 |
|
459 |
353 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
283 |
230 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
733 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
457 |
442 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
305 |
301 |
$9K |
| D1110 |
Prophylaxis - adult |
239 |
231 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
125 |
101 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
191 |
164 |
$7K |
| D0274 |
Bitewings - four radiographic images |
392 |
380 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
584 |
565 |
$3K |
| D1351 |
Sealant - per tooth |
60 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$253.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
28 |
$174.80 |
| D2940 |
|
13 |
12 |
$158.20 |
| D0601 |
|
112 |
111 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |