| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
739 |
732 |
$40K |
| D1120 |
Prophylaxis - child |
917 |
916 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
912 |
906 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
252 |
132 |
$20K |
| D1110 |
Prophylaxis - adult |
416 |
412 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
723 |
720 |
$14K |
| D1351 |
Sealant - per tooth |
412 |
122 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
72 |
$10K |
| D0272 |
Bitewings - two radiographic images |
438 |
438 |
$9K |
| D1206 |
Topical application of fluoride varnish |
366 |
366 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
298 |
$8K |
| D2140 |
|
113 |
70 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
94 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
99 |
96 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
133 |
$2K |
| D2160 |
|
13 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
70 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$186.30 |