| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,155 |
7,050 |
$124K |
| D1120 |
Prophylaxis - child |
4,780 |
4,702 |
$117K |
| D1206 |
Topical application of fluoride varnish |
7,444 |
7,333 |
$108K |
| D1110 |
Prophylaxis - adult |
2,471 |
2,439 |
$89K |
| D0272 |
Bitewings - two radiographic images |
2,240 |
2,206 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
256 |
81 |
$26K |
| D0330 |
Panoramic radiographic image |
507 |
497 |
$21K |
| D0274 |
Bitewings - four radiographic images |
815 |
803 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
890 |
846 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
477 |
$5K |
| D1351 |
Sealant - per tooth |
194 |
41 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
46 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
26 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
35 |
$851.04 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$281.49 |