| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
921 |
315 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
788 |
$23K |
| D1110 |
Prophylaxis - adult |
506 |
432 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
447 |
372 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
270 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
49 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
201 |
149 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
100 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
61 |
51 |
$2K |
| D2140 |
|
25 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
43 |
37 |
$1K |