| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0250 |
|
686 |
629 |
$36K |
| D1120 |
Prophylaxis - child |
700 |
644 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
939 |
868 |
$25K |
| D0272 |
Bitewings - two radiographic images |
736 |
678 |
$18K |
| D1206 |
Topical application of fluoride varnish |
881 |
815 |
$17K |
| D1110 |
Prophylaxis - adult |
236 |
219 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
120 |
70 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
223 |
195 |
$6K |
| D1351 |
Sealant - per tooth |
114 |
33 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
35 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
122 |
113 |
$2K |
| D0601 |
|
366 |
342 |
$2K |
| D2140 |
|
19 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$1K |
| D0603 |
|
201 |
184 |
$1K |
| D0602 |
|
160 |
145 |
$800.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
40 |
$571.22 |