| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,652 |
1,602 |
$66K |
| D0240 |
|
2,640 |
1,318 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,189 |
2,108 |
$48K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
752 |
351 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,701 |
1,647 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,733 |
1,674 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
308 |
283 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
145 |
$20K |
| D2140 |
|
286 |
135 |
$14K |
| D2160 |
|
89 |
65 |
$8K |
| D1120 |
Prophylaxis - child |
283 |
263 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
335 |
304 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
137 |
125 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
281 |
251 |
$4K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$815.10 |