| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,937 |
8,790 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
11,771 |
11,569 |
$269K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,698 |
10,526 |
$215K |
| D1110 |
Prophylaxis - adult |
3,812 |
3,743 |
$155K |
| D0272 |
Bitewings - two radiographic images |
6,334 |
6,250 |
$106K |
| D0330 |
Panoramic radiographic image |
1,545 |
1,500 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,212 |
1,995 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,167 |
1,154 |
$33K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
184 |
$16K |
| D1351 |
Sealant - per tooth |
473 |
137 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,092 |
1,078 |
$13K |
| D2140 |
|
186 |
121 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
29 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
151 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$248.05 |