| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,908 |
1,887 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,705 |
2,674 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,479 |
2,452 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,623 |
1,603 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
377 |
371 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
104 |
$25K |
| D1120 |
Prophylaxis - child |
564 |
555 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
800 |
614 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
544 |
$10K |
| D0602 |
|
1,258 |
1,242 |
$6K |
| D0274 |
Bitewings - four radiographic images |
335 |
333 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
78 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
159 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
213 |
$3K |
| D0601 |
|
424 |
420 |
$2K |
| D0330 |
Panoramic radiographic image |
92 |
92 |
$1K |
| D0603 |
|
42 |
42 |
$210.00 |