| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,252 |
731 |
$33K |
| D1120 |
Prophylaxis - child |
842 |
482 |
$30K |
| D2140 |
|
332 |
112 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
877 |
517 |
$17K |
| D0272 |
Bitewings - two radiographic images |
695 |
402 |
$17K |
| D1110 |
Prophylaxis - adult |
306 |
177 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
56 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
526 |
293 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
83 |
48 |
$7K |
| D1351 |
Sealant - per tooth |
189 |
37 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
195 |
107 |
$5K |
| D1206 |
Topical application of fluoride varnish |
256 |
141 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
311 |
173 |
$4K |
| D0602 |
|
199 |
107 |
$341.27 |
| D0603 |
|
387 |
209 |
$333.12 |