| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,795 |
5,128 |
$242K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,544 |
1,869 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
8,773 |
8,442 |
$221K |
| D1120 |
Prophylaxis - child |
6,700 |
6,444 |
$176K |
| D1206 |
Topical application of fluoride varnish |
9,426 |
9,057 |
$146K |
| D2140 |
|
1,366 |
1,098 |
$98K |
| D1110 |
Prophylaxis - adult |
2,584 |
2,483 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,380 |
3,238 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
668 |
418 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,135 |
1,972 |
$31K |
| D0274 |
Bitewings - four radiographic images |
837 |
827 |
$27K |
| D0330 |
Panoramic radiographic image |
489 |
478 |
$26K |
| D1351 |
Sealant - per tooth |
432 |
140 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
275 |
269 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
152 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
40 |
27 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
68 |
$1K |