| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,582 |
2,744 |
$92K |
| D1120 |
Prophylaxis - child |
2,686 |
2,055 |
$89K |
| D1206 |
Topical application of fluoride varnish |
3,583 |
2,748 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,665 |
2,062 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
3,516 |
2,645 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
433 |
144 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,253 |
2,468 |
$44K |
| D1110 |
Prophylaxis - adult |
854 |
675 |
$40K |
| D9248 |
|
401 |
306 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
483 |
202 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
911 |
687 |
$22K |
| D1351 |
Sealant - per tooth |
463 |
104 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
150 |
71 |
$12K |
| D0603 |
|
1,938 |
1,478 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
144 |
$6K |
| D0330 |
Panoramic radiographic image |
73 |
62 |
$4K |
| D2140 |
|
19 |
14 |
$1K |