| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,077 |
1,881 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,779 |
2,539 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,466 |
2,245 |
$54K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
687 |
375 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,718 |
2,481 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,627 |
1,240 |
$41K |
| D2160 |
|
309 |
157 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,453 |
1,356 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
716 |
636 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
87 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
887 |
831 |
$12K |
| D1120 |
Prophylaxis - child |
217 |
205 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$7K |
| D2140 |
|
87 |
28 |
$5K |
| D0330 |
Panoramic radiographic image |
112 |
81 |
$4K |
| D2332 |
|
27 |
13 |
$3K |
| D2161 |
|
14 |
12 |
$2K |