| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,682 |
2,585 |
$70K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
767 |
464 |
$61K |
| D1120 |
Prophylaxis - child |
1,480 |
1,429 |
$52K |
| D1110 |
Prophylaxis - adult |
1,070 |
1,031 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,455 |
2,370 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,856 |
1,799 |
$45K |
| D0240 |
|
1,811 |
1,749 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,030 |
1,943 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
323 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
915 |
822 |
$24K |
| D2140 |
|
223 |
146 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
81 |
$12K |
| D0603 |
|
1,391 |
1,332 |
$7K |
| D1351 |
Sealant - per tooth |
150 |
53 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
113 |
107 |
$4K |