| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
2,196 |
1,014 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,605 |
1,397 |
$41K |
| D1110 |
Prophylaxis - adult |
880 |
768 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,297 |
1,141 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,394 |
1,222 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
149 |
$26K |
| D1120 |
Prophylaxis - child |
691 |
595 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
123 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,279 |
912 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
269 |
207 |
$7K |
| D2140 |
|
98 |
63 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
393 |
274 |
$4K |
| D9110 |
|
51 |
46 |
$2K |
| D0601 |
|
299 |
239 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
24 |
$1K |
| D1351 |
Sealant - per tooth |
42 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
14 |
$742.40 |
| D0602 |
|
135 |
116 |
$595.30 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$315.40 |
| D1206 |
Topical application of fluoride varnish |
16 |
13 |
$299.25 |