| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,251 |
2,457 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,851 |
3,729 |
$76K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,335 |
603 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,319 |
1,803 |
$50K |
| D1120 |
Prophylaxis - child |
2,423 |
1,818 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,338 |
1,572 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
700 |
304 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,673 |
1,225 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,002 |
787 |
$20K |
| D1206 |
Topical application of fluoride varnish |
970 |
846 |
$18K |
| D2140 |
|
317 |
173 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
256 |
$12K |
| D0330 |
Panoramic radiographic image |
635 |
438 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
474 |
358 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
117 |
$8K |
| D1351 |
Sealant - per tooth |
288 |
79 |
$5K |
| D2160 |
|
46 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
359 |
257 |
$4K |
| D2331 |
|
25 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
90 |
$789.29 |
| D1203 |
|
145 |
79 |
$0.00 |