| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,547 |
1,537 |
$85K |
| D1120 |
Prophylaxis - child |
1,508 |
1,497 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,669 |
2,106 |
$42K |
| D8670 |
Periodic orthodontic treatment visit |
100 |
100 |
$24K |
| D2140 |
|
432 |
176 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,464 |
1,452 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,364 |
1,351 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
339 |
336 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
203 |
103 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
25 |
12 |
$12K |
| D9430 |
|
323 |
318 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
237 |
221 |
$9K |
| D1351 |
Sealant - per tooth |
297 |
113 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
608 |
602 |
$7K |
| D0350 |
|
509 |
244 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
71 |
$3K |
| D2954 |
|
23 |
12 |
$2K |