| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,808 |
1,737 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,679 |
2,544 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
651 |
622 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,199 |
2,154 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,830 |
1,778 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
390 |
227 |
$29K |
| D1120 |
Prophylaxis - child |
595 |
589 |
$21K |
| D2140 |
|
123 |
83 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
38 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
102 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
113 |
92 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
130 |
$2K |
| D1206 |
Topical application of fluoride varnish |
93 |
79 |
$2K |