| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
950 |
922 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,206 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
68 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
692 |
666 |
$13K |
| D0272 |
Bitewings - two radiographic images |
497 |
472 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
371 |
303 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
360 |
$6K |
| D2140 |
|
106 |
44 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
52 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
25 |
$3K |
| D1120 |
Prophylaxis - child |
48 |
48 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
15 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$947.60 |
| D1999 |
|
54 |
39 |
$0.00 |