| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,598 |
1,120 |
$40K |
| D1120 |
Prophylaxis - child |
1,170 |
924 |
$36K |
| D1351 |
Sealant - per tooth |
1,728 |
299 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
408 |
203 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,257 |
1,040 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,488 |
1,097 |
$27K |
| D1110 |
Prophylaxis - adult |
575 |
439 |
$23K |
| D2140 |
|
288 |
117 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
679 |
575 |
$13K |
| D0272 |
Bitewings - two radiographic images |
416 |
323 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
200 |
$9K |
| D0330 |
Panoramic radiographic image |
133 |
95 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
338 |
226 |
$3K |
| D0274 |
Bitewings - four radiographic images |
106 |
70 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
44 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
25 |
$228.50 |