| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,552 |
1,525 |
$63K |
| D1206 |
Topical application of fluoride varnish |
2,457 |
2,422 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,629 |
2,591 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
583 |
331 |
$42K |
| D1120 |
Prophylaxis - child |
1,140 |
1,130 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
1,017 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
288 |
271 |
$10K |
| D2140 |
|
132 |
81 |
$8K |
| D2160 |
|
72 |
41 |
$7K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
123 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
78 |
$922.25 |