| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,360 |
1,249 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,740 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
545 |
345 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,586 |
1,429 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
371 |
340 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,613 |
1,456 |
$31K |
| D1120 |
Prophylaxis - child |
677 |
600 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
595 |
497 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
444 |
391 |
$15K |
| D2160 |
|
112 |
83 |
$10K |
| D2140 |
|
92 |
59 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
231 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
78 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
54 |
$1K |