| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,052 |
3,169 |
$107K |
| D1120 |
Prophylaxis - child |
2,294 |
1,784 |
$81K |
| D1110 |
Prophylaxis - adult |
1,654 |
1,281 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,638 |
2,026 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
383 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
486 |
258 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,886 |
1,301 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,822 |
1,609 |
$36K |
| D2140 |
|
457 |
292 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,022 |
685 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
164 |
104 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,303 |
907 |
$23K |
| D1351 |
Sealant - per tooth |
501 |
184 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
914 |
613 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
285 |
272 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
86 |
$9K |
| D0603 |
|
1,818 |
1,289 |
$9K |
| D0602 |
|
661 |
517 |
$3K |
| D0601 |
|
73 |
67 |
$365.00 |