| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,876 |
1,708 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,613 |
2,389 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,381 |
1,266 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,198 |
1,087 |
$21K |
| D1120 |
Prophylaxis - child |
813 |
740 |
$18K |
| D0274 |
Bitewings - four radiographic images |
339 |
312 |
$10K |
| D0330 |
Panoramic radiographic image |
78 |
72 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
38 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
165 |
139 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
14 |
$433.30 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
28 |
$0.00 |