| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,520 |
2,416 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,040 |
3,889 |
$95K |
| D1120 |
Prophylaxis - child |
2,754 |
2,687 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,374 |
1,335 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,794 |
3,672 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,590 |
1,535 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,136 |
2,062 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,047 |
1,019 |
$21K |
| D2140 |
|
334 |
210 |
$20K |
| D0330 |
Panoramic radiographic image |
283 |
267 |
$12K |
| D4342 |
|
345 |
99 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
296 |
251 |
$8K |
| D4355 |
|
72 |
72 |
$6K |
| D1351 |
Sealant - per tooth |
180 |
61 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
42 |
$4K |
| D0274 |
Bitewings - four radiographic images |
124 |
119 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
89 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
12 |
$2K |
| D4910 |
|
15 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
73 |
$907.82 |