| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,056 |
907 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,787 |
1,556 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,401 |
1,224 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,578 |
1,378 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
341 |
201 |
$27K |
| D1120 |
Prophylaxis - child |
590 |
516 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
584 |
500 |
$15K |
| D2140 |
|
231 |
164 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
38 |
$6K |
| D0330 |
Panoramic radiographic image |
93 |
93 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$4K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
25 |
$961.80 |