| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,999 |
3,959 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,249 |
5,202 |
$124K |
| D1206 |
Topical application of fluoride varnish |
5,195 |
5,129 |
$106K |
| D1110 |
Prophylaxis - adult |
2,456 |
2,417 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,127 |
3,079 |
$53K |
| D0330 |
Panoramic radiographic image |
1,242 |
1,203 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,580 |
1,421 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
642 |
230 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
601 |
580 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
24 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
89 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
129 |
122 |
$1K |