| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,790 |
2,836 |
$100K |
| D1120 |
Prophylaxis - child |
2,664 |
1,977 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,664 |
2,726 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,656 |
2,012 |
$65K |
| D1110 |
Prophylaxis - adult |
1,105 |
848 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
535 |
242 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
871 |
648 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
227 |
146 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
249 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
417 |
298 |
$7K |
| D2140 |
|
40 |
13 |
$3K |
| D0603 |
|
419 |
227 |
$2K |
| D9248 |
|
13 |
13 |
$1K |
| D0602 |
|
119 |
72 |
$595.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$538.65 |
| D0601 |
|
19 |
19 |
$95.00 |