| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,403 |
1,359 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,423 |
2,366 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
800 |
523 |
$41K |
| D2140 |
|
1,097 |
671 |
$41K |
| D1120 |
Prophylaxis - child |
1,430 |
1,400 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,813 |
1,772 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,162 |
1,126 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
620 |
601 |
$16K |
| D1351 |
Sealant - per tooth |
307 |
86 |
$6K |
| D0330 |
Panoramic radiographic image |
111 |
108 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
331 |
299 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
965 |
897 |
$5K |
| D0272 |
Bitewings - two radiographic images |
425 |
406 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
431 |
210 |
$2K |
| D2331 |
|
35 |
27 |
$2K |
| D2160 |
|
17 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
29 |
$787.50 |
| D2330 |
|
14 |
12 |
$699.01 |