| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,345 |
3,775 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
5,284 |
4,683 |
$134K |
| D0272 |
Bitewings - two radiographic images |
4,823 |
4,212 |
$103K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,023 |
4,380 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
691 |
617 |
$56K |
| D1120 |
Prophylaxis - child |
836 |
709 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,021 |
821 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
657 |
514 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
156 |
81 |
$12K |
| D0601 |
|
2,515 |
2,219 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
132 |
$8K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
17 |
14 |
$6K |
| D0330 |
Panoramic radiographic image |
222 |
184 |
$6K |
| D2140 |
|
85 |
39 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
140 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
335 |
188 |
$4K |
| D0602 |
|
943 |
843 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
13 |
$2K |
| D0603 |
|
389 |
336 |
$1K |
| D1351 |
Sealant - per tooth |
42 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
26 |
15 |
$458.85 |