| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,490 |
3,657 |
$118K |
| D1110 |
Prophylaxis - adult |
2,403 |
1,981 |
$115K |
| D0272 |
Bitewings - two radiographic images |
3,684 |
3,017 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,453 |
3,634 |
$87K |
| D1120 |
Prophylaxis - child |
2,084 |
1,670 |
$74K |
| D2140 |
|
557 |
242 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
317 |
177 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
932 |
688 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
182 |
$19K |
| D1351 |
Sealant - per tooth |
77 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D1206 |
Topical application of fluoride varnish |
28 |
15 |
$558.60 |