| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
450 |
413 |
$9K |
| D1206 |
Topical application of fluoride varnish |
470 |
430 |
$9K |
| D1120 |
Prophylaxis - child |
308 |
276 |
$8K |
| D1110 |
Prophylaxis - adult |
175 |
164 |
$6K |
| D0603 |
|
280 |
248 |
$3K |
| D0272 |
Bitewings - two radiographic images |
150 |
132 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
58 |
$2K |
| D1330 |
|
353 |
314 |
$2K |
| D0274 |
Bitewings - four radiographic images |
50 |
50 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$280.62 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$104.88 |