| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,285 |
2,993 |
$85K |
| D1110 |
Prophylaxis - adult |
1,529 |
1,418 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,047 |
2,777 |
$59K |
| D1120 |
Prophylaxis - child |
1,671 |
1,497 |
$59K |
| D0272 |
Bitewings - two radiographic images |
2,422 |
2,217 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
746 |
300 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
292 |
190 |
$23K |
| D2140 |
|
362 |
213 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
781 |
685 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,157 |
1,026 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
638 |
588 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
630 |
525 |
$9K |
| D0601 |
|
1,302 |
1,185 |
$6K |
| D1351 |
Sealant - per tooth |
141 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$4K |
| D0330 |
Panoramic radiographic image |
71 |
65 |
$2K |
| D0602 |
|
375 |
359 |
$2K |