| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
956 |
907 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,319 |
1,256 |
$21K |
| D1110 |
Prophylaxis - adult |
657 |
627 |
$20K |
| D0330 |
Panoramic radiographic image |
470 |
447 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,064 |
1,022 |
$14K |
| D0272 |
Bitewings - two radiographic images |
654 |
619 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
565 |
526 |
$10K |
| D1351 |
Sealant - per tooth |
391 |
102 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
343 |
$7K |
| D2140 |
|
122 |
80 |
$6K |
| D1206 |
Topical application of fluoride varnish |
337 |
307 |
$5K |
| D0274 |
Bitewings - four radiographic images |
156 |
151 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
14 |
$840.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
26 |
$253.00 |