| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
605 |
521 |
$16K |
| D1110 |
Prophylaxis - adult |
325 |
274 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
639 |
527 |
$11K |
| D0272 |
Bitewings - two radiographic images |
461 |
399 |
$11K |
| D1120 |
Prophylaxis - child |
251 |
218 |
$9K |
| D1206 |
Topical application of fluoride varnish |
381 |
338 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
529 |
449 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
147 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
115 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
25 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
155 |
119 |
$3K |
| D2140 |
|
38 |
21 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
14 |
$2K |
| D0603 |
|
180 |
177 |
$855.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$564.30 |
| D0602 |
|
56 |
56 |
$275.00 |