| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,113 |
1,959 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,097 |
2,872 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,960 |
2,756 |
$67K |
| D2140 |
|
952 |
564 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,983 |
2,777 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,133 |
925 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,158 |
915 |
$30K |
| D1120 |
Prophylaxis - child |
731 |
666 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
216 |
112 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
95 |
$11K |
| D1351 |
Sealant - per tooth |
257 |
80 |
$7K |
| D0601 |
|
691 |
685 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
172 |
138 |
$3K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D0602 |
|
98 |
97 |
$485.00 |