| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
901 |
889 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,245 |
1,225 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,197 |
$23K |
| D0272 |
Bitewings - two radiographic images |
752 |
740 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
419 |
377 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
638 |
604 |
$10K |
| D1120 |
Prophylaxis - child |
218 |
214 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
14 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
65 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
150 |
$4K |
| D0274 |
Bitewings - four radiographic images |
167 |
156 |
$3K |
| D2140 |
|
48 |
39 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
157 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$411.89 |