| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,126 |
6,021 |
$159K |
| D1110 |
Prophylaxis - adult |
3,236 |
3,200 |
$151K |
| D1206 |
Topical application of fluoride varnish |
5,518 |
5,435 |
$106K |
| D0272 |
Bitewings - two radiographic images |
4,565 |
4,504 |
$102K |
| D1120 |
Prophylaxis - child |
2,039 |
2,019 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,219 |
1,960 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
374 |
$32K |
| D0603 |
|
3,137 |
3,099 |
$15K |
| D1351 |
Sealant - per tooth |
540 |
187 |
$15K |
| D2140 |
|
140 |
84 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
64 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
512 |
455 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
75 |
$8K |
| D0602 |
|
1,290 |
1,282 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
42 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
110 |
109 |
$1K |