| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,442 |
7,063 |
$179K |
| D1120 |
Prophylaxis - child |
5,450 |
5,158 |
$174K |
| D0272 |
Bitewings - two radiographic images |
5,662 |
5,414 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,757 |
5,498 |
$103K |
| D1110 |
Prophylaxis - adult |
1,691 |
1,632 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,749 |
1,631 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,390 |
1,301 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
317 |
301 |
$25K |
| D9248 |
|
300 |
262 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
163 |
101 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
321 |
177 |
$18K |
| D1351 |
Sealant - per tooth |
663 |
169 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
143 |
83 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
592 |
551 |
$10K |
| D0603 |
|
2,286 |
2,130 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
154 |
$5K |
| D0602 |
|
755 |
734 |
$3K |
| D0330 |
Panoramic radiographic image |
140 |
137 |
$2K |
| D2140 |
|
15 |
12 |
$983.25 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$866.40 |