| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,135 |
2,843 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,761 |
3,390 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,762 |
3,399 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,698 |
3,328 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
3,840 |
3,438 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,524 |
3,156 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
573 |
304 |
$42K |
| D1120 |
Prophylaxis - child |
1,050 |
934 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
952 |
798 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
258 |
243 |
$20K |
| D2140 |
|
310 |
179 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
84 |
36 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
120 |
$5K |
| D1206 |
Topical application of fluoride varnish |
198 |
186 |
$4K |
| D1351 |
Sealant - per tooth |
78 |
13 |
$2K |