| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,366 |
11,664 |
$317K |
| D1110 |
Prophylaxis - adult |
6,565 |
6,200 |
$304K |
| D0272 |
Bitewings - two radiographic images |
10,746 |
10,138 |
$242K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,267 |
11,573 |
$237K |
| D1120 |
Prophylaxis - child |
5,736 |
5,415 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
1,050 |
1,034 |
$80K |
| D2140 |
|
939 |
433 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,915 |
1,610 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
579 |
358 |
$45K |
| D1351 |
Sealant - per tooth |
661 |
168 |
$17K |
| D0330 |
Panoramic radiographic image |
604 |
568 |
$11K |
| D7111 |
|
58 |
41 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
73 |
$2K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$518.70 |