| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,417 |
1,289 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,280 |
2,058 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,389 |
2,180 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,885 |
1,747 |
$42K |
| D1120 |
Prophylaxis - child |
965 |
877 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,848 |
1,666 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
334 |
293 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,698 |
1,538 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
605 |
520 |
$15K |
| D2140 |
|
145 |
49 |
$9K |
| D1351 |
Sealant - per tooth |
277 |
93 |
$7K |
| D0602 |
|
762 |
753 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
109 |
107 |
$3K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$3K |
| D9920 |
|
145 |
143 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
12 |
$1K |
| D0601 |
|
259 |
252 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$786.60 |
| D0603 |
|
102 |
100 |
$490.16 |