| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,352 |
1,329 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,904 |
1,878 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,055 |
2,020 |
$42K |
| D2160 |
|
202 |
108 |
$16K |
| D0330 |
Panoramic radiographic image |
355 |
345 |
$16K |
| D0272 |
Bitewings - two radiographic images |
887 |
864 |
$14K |
| D1120 |
Prophylaxis - child |
432 |
423 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
264 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
63 |
42 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
93 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
222 |
$3K |
| D1999 |
|
12 |
12 |
$0.00 |