| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,395 |
3,034 |
$81K |
| D1110 |
Prophylaxis - adult |
1,534 |
1,375 |
$68K |
| D0272 |
Bitewings - two radiographic images |
2,687 |
2,400 |
$55K |
| D1120 |
Prophylaxis - child |
1,692 |
1,506 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,725 |
2,443 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
469 |
200 |
$34K |
| D1351 |
Sealant - per tooth |
830 |
245 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
542 |
486 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
172 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
172 |
$3K |
| D0603 |
|
745 |
655 |
$3K |
| D1206 |
Topical application of fluoride varnish |
161 |
142 |
$3K |
| D0602 |
|
679 |
575 |
$3K |
| D0601 |
|
670 |
553 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$2K |
| D2140 |
|
24 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
15 |
$867.80 |
| D0240 |
|
24 |
14 |
$335.80 |