| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,518 |
1,176 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,622 |
1,999 |
$68K |
| D8670 |
Periodic orthodontic treatment visit |
521 |
182 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
481 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,267 |
1,752 |
$44K |
| D2140 |
|
566 |
314 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,554 |
1,216 |
$36K |
| D1120 |
Prophylaxis - child |
833 |
622 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
381 |
133 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,029 |
624 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
802 |
564 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
324 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
12 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
37 |
24 |
$3K |
| D0601 |
|
604 |
491 |
$3K |
| D0602 |
|
269 |
190 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
69 |
$969.00 |