| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,120 |
2,149 |
$69K |
| D1120 |
Prophylaxis - child |
3,532 |
2,552 |
$65K |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,071 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
701 |
197 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,940 |
1,360 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,055 |
761 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
599 |
573 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
255 |
118 |
$13K |
| D2140 |
|
404 |
146 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
186 |
153 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
402 |
250 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
141 |
89 |
$888.86 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
232 |
202 |
$615.00 |