| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,456 |
1,456 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,972 |
1,972 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
514 |
268 |
$39K |
| D2140 |
|
666 |
375 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,953 |
1,953 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
944 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,031 |
939 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
383 |
240 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,712 |
1,712 |
$28K |
| D1120 |
Prophylaxis - child |
792 |
792 |
$27K |
| D0330 |
Panoramic radiographic image |
486 |
486 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,308 |
1,277 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
38 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
169 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
197 |
196 |
$2K |
| D1351 |
Sealant - per tooth |
66 |
24 |
$2K |