| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
497 |
268 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
88 |
30 |
$12K |
| D1120 |
Prophylaxis - child |
319 |
171 |
$11K |
| D1110 |
Prophylaxis - adult |
165 |
91 |
$8K |
| D0272 |
Bitewings - two radiographic images |
324 |
181 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
40 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
176 |
$6K |
| D2140 |
|
95 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
137 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
17 |
$3K |
| D1206 |
Topical application of fluoride varnish |
133 |
71 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
48 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
175 |
95 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
31 |
$2K |
| D0602 |
|
188 |
103 |
$1.77 |
| D0603 |
|
159 |
85 |
$1.52 |