| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,164 |
1,417 |
$57K |
| D1120 |
Prophylaxis - child |
1,471 |
937 |
$53K |
| D2140 |
|
690 |
300 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
539 |
232 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
231 |
68 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,542 |
1,012 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,267 |
834 |
$31K |
| D1110 |
Prophylaxis - adult |
592 |
416 |
$28K |
| D1351 |
Sealant - per tooth |
707 |
188 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
131 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
651 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
547 |
345 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
737 |
459 |
$10K |
| D1206 |
Topical application of fluoride varnish |
461 |
297 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
262 |
178 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
42 |
$8K |
| D0602 |
|
719 |
458 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$941.10 |
| D0603 |
|
680 |
407 |
$929.90 |
| D0601 |
|
32 |
16 |
$0.30 |