| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
3,282 |
1,912 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
8,428 |
8,066 |
$160K |
| D1120 |
Prophylaxis - child |
5,454 |
5,240 |
$148K |
| D0330 |
Panoramic radiographic image |
3,015 |
2,859 |
$140K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,467 |
5,255 |
$82K |
| D1110 |
Prophylaxis - adult |
2,892 |
2,743 |
$75K |
| D2140 |
|
431 |
273 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
735 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
799 |
690 |
$14K |
| D0274 |
Bitewings - four radiographic images |
362 |
348 |
$10K |
| D0272 |
Bitewings - two radiographic images |
382 |
364 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
51 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$338.28 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$167.97 |