| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,114 |
2,846 |
$108K |
| D1110 |
Prophylaxis - adult |
2,271 |
1,559 |
$108K |
| D0272 |
Bitewings - two radiographic images |
3,566 |
2,471 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,788 |
2,626 |
$75K |
| D1120 |
Prophylaxis - child |
1,851 |
1,293 |
$66K |
| D2140 |
|
883 |
420 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
699 |
340 |
$55K |
| D1351 |
Sealant - per tooth |
1,602 |
365 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,163 |
757 |
$30K |
| D0603 |
|
1,964 |
1,271 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
273 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
50 |
$6K |
| D0602 |
|
750 |
432 |
$4K |
| D1206 |
Topical application of fluoride varnish |
108 |
63 |
$2K |
| D0240 |
|
85 |
30 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
25 |
$1K |