| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,030 |
3,004 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,264 |
699 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,317 |
2,298 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
908 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
549 |
231 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,897 |
2,873 |
$29K |
| D2140 |
|
480 |
332 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,228 |
1,219 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
494 |
492 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
404 |
$22K |
| D1351 |
Sealant - per tooth |
842 |
327 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,309 |
1,034 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
34 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
964 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
29 |
16 |
$7K |
| D0272 |
Bitewings - two radiographic images |
485 |
483 |
$5K |
| D9430 |
|
122 |
120 |
$4K |
| D0350 |
|
486 |
351 |
$4K |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
55 |
54 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$982.80 |
| D9610 |
|
47 |
47 |
$210.00 |