| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,314 |
1,252 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,720 |
1,625 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,820 |
1,719 |
$25K |
| D1110 |
Prophylaxis - adult |
693 |
652 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,341 |
1,173 |
$19K |
| D0272 |
Bitewings - two radiographic images |
779 |
737 |
$13K |
| D2140 |
|
225 |
196 |
$9K |
| D0274 |
Bitewings - four radiographic images |
364 |
341 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
107 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
65 |
$5K |
| D0330 |
Panoramic radiographic image |
104 |
97 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
40 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
128 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
13 |
$906.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$357.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$193.00 |