| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
649 |
642 |
$15K |
| D1120 |
Prophylaxis - child |
476 |
471 |
$15K |
| D0240 |
|
547 |
278 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
143 |
79 |
$11K |
| D1206 |
Topical application of fluoride varnish |
631 |
623 |
$10K |
| D0272 |
Bitewings - two radiographic images |
422 |
417 |
$9K |
| D1110 |
Prophylaxis - adult |
135 |
133 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
122 |
$3K |
| D0603 |
|
342 |
340 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$849.20 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$505.40 |