| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,040 |
1,942 |
$12K |
| D1120 |
Prophylaxis - child |
1,151 |
1,088 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,129 |
2,025 |
$9K |
| D0272 |
Bitewings - two radiographic images |
1,714 |
1,687 |
$8K |
| D1110 |
Prophylaxis - adult |
660 |
627 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,953 |
1,887 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
282 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,782 |
1,731 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
344 |
172 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
267 |
148 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
394 |
329 |
$2K |
| D2140 |
|
59 |
43 |
$1K |
| D1351 |
Sealant - per tooth |
37 |
12 |
$441.60 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |