| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,134 |
5,037 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
6,187 |
6,066 |
$155K |
| D1206 |
Topical application of fluoride varnish |
6,370 |
6,253 |
$133K |
| D1110 |
Prophylaxis - adult |
1,346 |
1,318 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,279 |
2,229 |
$52K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
271 |
63 |
$30K |
| D1351 |
Sealant - per tooth |
993 |
264 |
$26K |
| D0330 |
Panoramic radiographic image |
366 |
364 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,463 |
1,350 |
$20K |
| D0274 |
Bitewings - four radiographic images |
549 |
532 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,151 |
1,127 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
53 |
28 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
350 |
152 |
$3K |
| D9310 |
|
113 |
90 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$1K |
| D0240 |
|
87 |
69 |
$1K |