| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,980 |
1,947 |
$46K |
| D1120 |
Prophylaxis - child |
1,346 |
1,324 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
534 |
391 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,858 |
1,828 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,622 |
1,590 |
$29K |
| D1110 |
Prophylaxis - adult |
577 |
563 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,403 |
1,186 |
$23K |
| D0330 |
Panoramic radiographic image |
458 |
447 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,341 |
1,296 |
$16K |
| D1351 |
Sealant - per tooth |
398 |
112 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
333 |
289 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
244 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
30 |
$2K |
| D2140 |
|
34 |
27 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
28 |
$634.40 |