| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,336 |
2,287 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,484 |
3,390 |
$85K |
| D0272 |
Bitewings - two radiographic images |
3,012 |
2,944 |
$69K |
| D1120 |
Prophylaxis - child |
1,483 |
1,449 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,624 |
2,576 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
354 |
352 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
753 |
697 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
220 |
157 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
180 |
$6K |
| D0330 |
Panoramic radiographic image |
102 |
99 |
$5K |
| D2140 |
|
77 |
63 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
278 |
267 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
16 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$1K |