| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,359 |
1,136 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,834 |
1,559 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,510 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
412 |
231 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,287 |
1,134 |
$24K |
| D2140 |
|
442 |
231 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
260 |
58 |
$17K |
| D0330 |
Panoramic radiographic image |
449 |
407 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
166 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
460 |
$16K |
| D1120 |
Prophylaxis - child |
290 |
250 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
14 |
$5K |
| D1351 |
Sealant - per tooth |
175 |
38 |
$4K |
| D1320 |
|
112 |
103 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
14 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
39 |
$703.45 |
| D9920 |
|
25 |
25 |
$500.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$319.20 |