| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,819 |
2,783 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
4,435 |
4,381 |
$113K |
| D0272 |
Bitewings - two radiographic images |
3,666 |
3,621 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,910 |
3,860 |
$75K |
| D1120 |
Prophylaxis - child |
1,700 |
1,681 |
$58K |
| D0240 |
|
2,267 |
1,138 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,167 |
1,043 |
$29K |
| D2140 |
|
194 |
100 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
583 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
68 |
24 |
$9K |
| D1351 |
Sealant - per tooth |
298 |
74 |
$8K |
| D0601 |
|
1,282 |
1,262 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
179 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
44 |
$5K |
| D0602 |
|
931 |
918 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
38 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0603 |
|
218 |
211 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
12 |
$199.50 |
| D1999 |
|
46 |
44 |
$0.00 |