| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
9,632 |
9,476 |
$241K |
| D1120 |
Prophylaxis - child |
6,189 |
6,090 |
$204K |
| D1206 |
Topical application of fluoride varnish |
8,810 |
8,670 |
$166K |
| D1110 |
Prophylaxis - adult |
3,682 |
3,630 |
$164K |
| D0272 |
Bitewings - two radiographic images |
4,717 |
4,637 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,796 |
1,703 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
214 |
48 |
$27K |
| D0603 |
|
5,148 |
5,069 |
$19K |
| D1351 |
Sealant - per tooth |
374 |
107 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
491 |
$8K |
| D0602 |
|
2,060 |
2,035 |
$8K |
| D9248 |
|
83 |
80 |
$8K |
| D0601 |
|
1,967 |
1,937 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
38 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$1K |