| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,840 |
2,788 |
$38K |
| D1206 |
Topical application of fluoride varnish |
3,120 |
3,072 |
$36K |
| D1120 |
Prophylaxis - child |
1,723 |
1,701 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,147 |
1,113 |
$35K |
| D1110 |
Prophylaxis - adult |
1,201 |
1,177 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,399 |
1,376 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
377 |
253 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
78 |
49 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
140 |
$3K |
| D7111 |
|
50 |
27 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
17 |
$848.30 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$690.82 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$480.85 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
53 |
$438.45 |