| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,019 |
1,009 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,096 |
1,090 |
$24K |
| D0330 |
Panoramic radiographic image |
328 |
323 |
$16K |
| D0272 |
Bitewings - two radiographic images |
850 |
841 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
105 |
$15K |
| D1206 |
Topical application of fluoride varnish |
631 |
625 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
222 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
637 |
604 |
$8K |
| D2332 |
|
79 |
46 |
$8K |
| D1120 |
Prophylaxis - child |
113 |
113 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
98 |
$4K |
| D2160 |
|
36 |
30 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
14 |
$2K |
| D2330 |
|
18 |
13 |
$1K |