| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,347 |
1,263 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,922 |
1,798 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,682 |
1,569 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
365 |
345 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,274 |
1,213 |
$24K |
| D0272 |
Bitewings - two radiographic images |
942 |
900 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,256 |
1,144 |
$16K |
| D1120 |
Prophylaxis - child |
246 |
237 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
219 |
$8K |
| D1206 |
Topical application of fluoride varnish |
200 |
179 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
41 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$855.00 |
| D0601 |
|
40 |
30 |
$180.00 |