| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,607 |
2,457 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
2,500 |
2,344 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,351 |
2,205 |
$58K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
736 |
582 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,145 |
1,082 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
346 |
265 |
$15K |
| D1110 |
Prophylaxis - adult |
427 |
392 |
$15K |
| D2140 |
|
391 |
322 |
$12K |
| D1351 |
Sealant - per tooth |
257 |
102 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
397 |
388 |
$8K |
| D0330 |
Panoramic radiographic image |
372 |
350 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
285 |
261 |
$7K |
| D1206 |
Topical application of fluoride varnish |
198 |
198 |
$5K |
| D2160 |
|
86 |
80 |
$5K |
| D0272 |
Bitewings - two radiographic images |
468 |
447 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
326 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$253.90 |