| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,600 |
1,561 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,037 |
2,003 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,025 |
1,010 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
886 |
$18K |
| D1206 |
Topical application of fluoride varnish |
781 |
762 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
123 |
$10K |
| D1120 |
Prophylaxis - child |
293 |
292 |
$10K |
| D0274 |
Bitewings - four radiographic images |
355 |
349 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
83 |
54 |
$6K |
| D0601 |
|
705 |
697 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
73 |
$2K |
| D2140 |
|
28 |
24 |
$2K |
| D1351 |
Sealant - per tooth |
72 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
69 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$410.40 |
| D0602 |
|
15 |
15 |
$70.00 |
| D1999 |
|
131 |
129 |
$0.00 |