| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,978 |
3,539 |
$100K |
| D1110 |
Prophylaxis - adult |
2,075 |
1,859 |
$93K |
| D0272 |
Bitewings - two radiographic images |
3,446 |
3,075 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,721 |
3,315 |
$71K |
| D1120 |
Prophylaxis - child |
1,957 |
1,728 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
846 |
703 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
763 |
624 |
$19K |
| D0240 |
|
616 |
334 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
124 |
$11K |
| D0602 |
|
2,299 |
2,086 |
$11K |
| D2140 |
|
146 |
68 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
64 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
342 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
72 |
40 |
$5K |
| D0330 |
Panoramic radiographic image |
155 |
129 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
85 |
$3K |
| D1351 |
Sealant - per tooth |
42 |
12 |
$1K |
| D0601 |
|
245 |
242 |
$1K |