| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,151 |
10,030 |
$256K |
| D1110 |
Prophylaxis - adult |
4,588 |
4,518 |
$208K |
| D1120 |
Prophylaxis - child |
5,514 |
5,466 |
$181K |
| D1206 |
Topical application of fluoride varnish |
9,017 |
8,912 |
$172K |
| D0272 |
Bitewings - two radiographic images |
4,867 |
4,805 |
$109K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,297 |
2,186 |
$56K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
272 |
97 |
$38K |
| D9248 |
|
226 |
213 |
$21K |
| D0603 |
|
5,392 |
5,322 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
726 |
698 |
$12K |
| D1351 |
Sealant - per tooth |
478 |
134 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
172 |
89 |
$11K |
| D0602 |
|
2,814 |
2,787 |
$10K |
| D0601 |
|
1,431 |
1,417 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
117 |
$4K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
51 |
$2K |
| D2140 |
|
22 |
12 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |