| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,909 |
2,847 |
$103K |
| D1110 |
Prophylaxis - adult |
1,878 |
1,410 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,666 |
2,699 |
$72K |
| D1120 |
Prophylaxis - child |
1,931 |
1,369 |
$69K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
806 |
412 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,760 |
2,031 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
421 |
295 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,330 |
950 |
$34K |
| D2140 |
|
337 |
205 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
152 |
38 |
$21K |
| D0603 |
|
2,587 |
1,767 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
345 |
$9K |
| D2160 |
|
19 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
24 |
$1K |
| D1206 |
Topical application of fluoride varnish |
60 |
31 |
$1K |
| D0602 |
|
83 |
44 |
$415.00 |