| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,815 |
5,815 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
9,756 |
9,756 |
$221K |
| D1120 |
Prophylaxis - child |
6,172 |
6,172 |
$212K |
| D0272 |
Bitewings - two radiographic images |
10,267 |
10,267 |
$191K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,484 |
1,683 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,473 |
10,473 |
$168K |
| D2140 |
|
1,969 |
1,340 |
$112K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,493 |
3,455 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,252 |
2,252 |
$89K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,061 |
779 |
$88K |
| D0330 |
Panoramic radiographic image |
1,306 |
1,306 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,660 |
1,655 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,857 |
3,827 |
$47K |
| D1351 |
Sealant - per tooth |
1,418 |
516 |
$41K |
| D0274 |
Bitewings - four radiographic images |
527 |
527 |
$15K |
| D2160 |
|
137 |
110 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
565 |
549 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$2K |
| D2330 |
|
22 |
13 |
$1K |