| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,156 |
3,099 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
5,497 |
5,417 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,840 |
5,762 |
$112K |
| D0272 |
Bitewings - two radiographic images |
3,717 |
3,661 |
$84K |
| D1120 |
Prophylaxis - child |
2,203 |
2,175 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
765 |
476 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
963 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
476 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
86 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
185 |
180 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
466 |
442 |
$12K |
| D0274 |
Bitewings - four radiographic images |
461 |
456 |
$9K |
| D0240 |
|
186 |
99 |
$4K |
| D2160 |
|
34 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
40 |
40 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$1K |
| D2140 |
|
15 |
12 |
$963.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$185.25 |