| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,652 |
1,611 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,584 |
1,543 |
$23K |
| D1110 |
Prophylaxis - adult |
585 |
579 |
$20K |
| D1120 |
Prophylaxis - child |
745 |
730 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
178 |
124 |
$15K |
| D1351 |
Sealant - per tooth |
316 |
87 |
$8K |
| D2140 |
|
109 |
79 |
$8K |
| D0274 |
Bitewings - four radiographic images |
160 |
157 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
49 |
$4K |
| D0272 |
Bitewings - two radiographic images |
262 |
262 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
104 |
103 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
85 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
182 |
176 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
29 |
26 |
$1K |
| D2331 |
|
17 |
12 |
$908.68 |