| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,966 |
3,831 |
$98K |
| D1110 |
Prophylaxis - adult |
2,021 |
1,954 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,984 |
3,840 |
$73K |
| D0272 |
Bitewings - two radiographic images |
2,967 |
2,874 |
$63K |
| D1120 |
Prophylaxis - child |
1,461 |
1,406 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
345 |
312 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
119 |
69 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
403 |
384 |
$6K |
| D1351 |
Sealant - per tooth |
109 |
26 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
50 |
$2K |
| D0274 |
Bitewings - four radiographic images |
54 |
53 |
$1K |
| D0330 |
Panoramic radiographic image |
42 |
40 |
$940.50 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
13 |
$440.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$171.00 |