| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,370 |
3,229 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,850 |
4,658 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,582 |
892 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,943 |
4,723 |
$68K |
| D1110 |
Prophylaxis - adult |
1,834 |
1,753 |
$63K |
| D2140 |
|
1,329 |
785 |
$62K |
| D0330 |
Panoramic radiographic image |
1,252 |
1,180 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
845 |
570 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,012 |
1,932 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,190 |
1,125 |
$26K |
| D1206 |
Topical application of fluoride varnish |
447 |
433 |
$9K |
| D1351 |
Sealant - per tooth |
313 |
104 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
358 |
329 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
247 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
165 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
30 |
$730.00 |