| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,982 |
3,840 |
$102K |
| D1120 |
Prophylaxis - child |
2,588 |
2,498 |
$88K |
| D0272 |
Bitewings - two radiographic images |
2,952 |
2,847 |
$66K |
| D1110 |
Prophylaxis - adult |
1,309 |
1,267 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,085 |
3,010 |
$60K |
| D1351 |
Sealant - per tooth |
1,383 |
381 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,447 |
1,254 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
438 |
240 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
323 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
171 |
$19K |
| D1206 |
Topical application of fluoride varnish |
843 |
778 |
$16K |
| D2140 |
|
117 |
83 |
$7K |
| D0601 |
|
1,166 |
1,123 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
66 |
$5K |
| D0330 |
Panoramic radiographic image |
125 |
124 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
14 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
96 |
$2K |
| D0602 |
|
304 |
295 |
$1K |
| D0603 |
|
203 |
194 |
$975.68 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$732.40 |