| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,263 |
1,110 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,832 |
1,597 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,019 |
1,757 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,608 |
1,394 |
$36K |
| D1120 |
Prophylaxis - child |
834 |
712 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
686 |
567 |
$22K |
| D2140 |
|
320 |
175 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
140 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
26 |
$8K |
| D1351 |
Sealant - per tooth |
120 |
44 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
122 |
85 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
48 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
18 |
$399.00 |