| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
466 |
445 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
845 |
802 |
$22K |
| D0272 |
Bitewings - two radiographic images |
639 |
604 |
$15K |
| D1120 |
Prophylaxis - child |
372 |
351 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
674 |
623 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
500 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
577 |
541 |
$8K |
| D1206 |
Topical application of fluoride varnish |
251 |
236 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
40 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
115 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
14 |
$2K |
| D0601 |
|
263 |
244 |
$1K |
| D2140 |
|
19 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
31 |
$985.00 |
| D0602 |
|
31 |
30 |
$155.00 |