| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
627 |
504 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
698 |
558 |
$18K |
| D1206 |
Topical application of fluoride varnish |
411 |
296 |
$9K |
| D0274 |
Bitewings - four radiographic images |
458 |
390 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
268 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
117 |
75 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
175 |
$4K |
| D0330 |
Panoramic radiographic image |
170 |
150 |
$3K |
| D1110 |
Prophylaxis - adult |
48 |
47 |
$2K |
| D1354 |
|
96 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
173 |
129 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
160 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$895.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
120 |
119 |
$575.68 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
12 |
$524.20 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$455.96 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$151.15 |