| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,098 |
1,011 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,469 |
1,357 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,040 |
959 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
309 |
196 |
$12K |
| D0274 |
Bitewings - four radiographic images |
508 |
462 |
$10K |
| D1120 |
Prophylaxis - child |
573 |
534 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
247 |
222 |
$5K |
| D2160 |
|
77 |
56 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
177 |
151 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
195 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
129 |
$426.00 |
| D1351 |
Sealant - per tooth |
31 |
13 |
$29.35 |
| D2140 |
|
16 |
12 |
$0.00 |