| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,167 |
3,075 |
$82K |
| D1120 |
Prophylaxis - child |
2,212 |
2,194 |
$75K |
| D1110 |
Prophylaxis - adult |
1,527 |
1,449 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,722 |
2,694 |
$53K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
654 |
378 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,585 |
1,337 |
$50K |
| D0272 |
Bitewings - two radiographic images |
1,952 |
1,921 |
$37K |
| D2140 |
|
504 |
283 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
565 |
274 |
$25K |
| D0330 |
Panoramic radiographic image |
450 |
413 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
399 |
344 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
632 |
569 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
116 |
116 |
$5K |
| D2330 |
|
45 |
27 |
$3K |
| D1206 |
Topical application of fluoride varnish |
67 |
67 |
$2K |