| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,822 |
7,716 |
$191K |
| D1120 |
Prophylaxis - child |
5,198 |
5,147 |
$172K |
| D1110 |
Prophylaxis - adult |
2,064 |
2,016 |
$93K |
| D0330 |
Panoramic radiographic image |
1,575 |
1,551 |
$91K |
| D0272 |
Bitewings - two radiographic images |
2,059 |
2,026 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
827 |
745 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
573 |
437 |
$42K |
| D2140 |
|
519 |
376 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
675 |
660 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,292 |
1,279 |
$23K |
| D1351 |
Sealant - per tooth |
479 |
234 |
$16K |
| D1330 |
|
616 |
607 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
582 |
571 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
204 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
113 |
$4K |