| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,562 |
2,527 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,834 |
1,802 |
$55K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
617 |
380 |
$50K |
| D2140 |
|
747 |
399 |
$47K |
| D0330 |
Panoramic radiographic image |
744 |
739 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,404 |
2,364 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,489 |
$37K |
| D1110 |
Prophylaxis - adult |
567 |
560 |
$20K |
| D0274 |
Bitewings - four radiographic images |
471 |
463 |
$17K |
| D0272 |
Bitewings - two radiographic images |
328 |
327 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
264 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
88 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$211.08 |