| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,764 |
4,758 |
$136K |
| D1110 |
Prophylaxis - adult |
2,637 |
2,630 |
$132K |
| D1120 |
Prophylaxis - child |
2,521 |
2,514 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,882 |
2,879 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,410 |
2,401 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,444 |
1,263 |
$49K |
| D0330 |
Panoramic radiographic image |
384 |
384 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
192 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
556 |
534 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
49 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
27 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
97 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$832.41 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$461.88 |