| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,447 |
1,440 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,375 |
1,355 |
$36K |
| D1110 |
Prophylaxis - adult |
616 |
605 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
617 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,023 |
1,015 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
559 |
482 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
160 |
99 |
$14K |
| D0272 |
Bitewings - two radiographic images |
492 |
489 |
$10K |
| D1206 |
Topical application of fluoride varnish |
376 |
375 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
134 |
$8K |
| D0330 |
Panoramic radiographic image |
125 |
124 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
215 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
156 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$630.37 |