| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,056 |
1,763 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,153 |
887 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,043 |
1,752 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
671 |
641 |
$18K |
| D0274 |
Bitewings - four radiographic images |
510 |
409 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
268 |
62 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
172 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
401 |
230 |
$5K |
| D0330 |
Panoramic radiographic image |
200 |
134 |
$5K |
| D2160 |
|
103 |
24 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$291.72 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$167.04 |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
15 |
$0.00 |