| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,017 |
983 |
$35K |
| D1120 |
Prophylaxis - child |
716 |
686 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
967 |
937 |
$24K |
| D1110 |
Prophylaxis - adult |
364 |
352 |
$21K |
| D0272 |
Bitewings - two radiographic images |
538 |
521 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
192 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
13 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
448 |
413 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
412 |
182 |
$4K |
| D7111 |
|
54 |
27 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
37 |
$2K |
| D1351 |
Sealant - per tooth |
47 |
14 |
$1K |