| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,345 |
4,816 |
$139K |
| D1110 |
Prophylaxis - adult |
2,657 |
2,406 |
$125K |
| D1206 |
Topical application of fluoride varnish |
5,233 |
4,732 |
$102K |
| D1120 |
Prophylaxis - child |
2,697 |
2,428 |
$95K |
| D2140 |
|
1,460 |
824 |
$94K |
| D0272 |
Bitewings - two radiographic images |
3,902 |
3,537 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,165 |
668 |
$92K |
| D0240 |
|
3,248 |
2,733 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,052 |
3,617 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
703 |
618 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,843 |
1,647 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
453 |
396 |
$15K |
| D7111 |
|
284 |
154 |
$13K |
| D0603 |
|
2,661 |
2,463 |
$13K |
| D1351 |
Sealant - per tooth |
425 |
152 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
78 |
54 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
634 |
602 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
13 |
$3K |
| D2160 |
|
20 |
12 |
$2K |
| D0601 |
|
24 |
17 |
$120.00 |
| D0602 |
|
12 |
12 |
$60.00 |