| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,527 |
511 |
$101K |
| D1110 |
Prophylaxis - adult |
1,255 |
1,228 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,569 |
$37K |
| D0330 |
Panoramic radiographic image |
449 |
440 |
$21K |
| D1120 |
Prophylaxis - child |
627 |
620 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
676 |
664 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
862 |
846 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
573 |
489 |
$17K |
| D9110 |
|
242 |
220 |
$10K |
| D1206 |
Topical application of fluoride varnish |
458 |
452 |
$9K |
| D5110 |
|
12 |
12 |
$8K |
| D0274 |
Bitewings - four radiographic images |
278 |
272 |
$7K |
| D2140 |
|
108 |
72 |
$6K |
| D2330 |
|
99 |
56 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
58 |
39 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
42 |
$5K |
| D0272 |
Bitewings - two radiographic images |
231 |
228 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
236 |
224 |
$3K |