| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,296 |
2,282 |
$48K |
| D1120 |
Prophylaxis - child |
1,404 |
1,401 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,450 |
2,437 |
$37K |
| D1110 |
Prophylaxis - adult |
753 |
747 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
546 |
503 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
66 |
39 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
649 |
145 |
$5K |
| D0330 |
Panoramic radiographic image |
104 |
96 |
$5K |
| D0274 |
Bitewings - four radiographic images |
171 |
168 |
$5K |
| D0272 |
Bitewings - two radiographic images |
237 |
237 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
156 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
67 |
$2K |
| D1351 |
Sealant - per tooth |
61 |
26 |
$1K |
| D2140 |
|
21 |
13 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$981.84 |
| D0601 |
|
55 |
55 |
$503.25 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$408.69 |