| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,778 |
1,617 |
$46K |
| D1120 |
Prophylaxis - child |
1,184 |
1,090 |
$41K |
| D1110 |
Prophylaxis - adult |
907 |
812 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,054 |
895 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,630 |
1,509 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,424 |
1,307 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
94 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
86 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
811 |
634 |
$9K |
| D2140 |
|
66 |
40 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
76 |
$4K |
| D1351 |
Sealant - per tooth |
42 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
33 |
26 |
$1K |