| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,049 |
808 |
$28K |
| D1120 |
Prophylaxis - child |
711 |
537 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
277 |
166 |
$22K |
| D0272 |
Bitewings - two radiographic images |
638 |
497 |
$15K |
| D1110 |
Prophylaxis - adult |
295 |
242 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
694 |
539 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
74 |
29 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
82 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
473 |
352 |
$8K |
| D1351 |
Sealant - per tooth |
295 |
72 |
$8K |
| D2140 |
|
113 |
53 |
$7K |
| D1206 |
Topical application of fluoride varnish |
287 |
222 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
192 |
132 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
244 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
28 |
$1K |
| D0602 |
|
322 |
244 |
$1K |
| D0603 |
|
229 |
181 |
$820.65 |