| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,042 |
1,910 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,823 |
2,630 |
$72K |
| D0240 |
|
2,933 |
1,421 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,351 |
2,217 |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
569 |
292 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,603 |
1,458 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
188 |
$18K |
| D1206 |
Topical application of fluoride varnish |
856 |
817 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
554 |
458 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
527 |
463 |
$9K |
| D1120 |
Prophylaxis - child |
215 |
190 |
$8K |
| D1351 |
Sealant - per tooth |
206 |
56 |
$6K |
| D2160 |
|
59 |
37 |
$5K |
| D0330 |
Panoramic radiographic image |
103 |
98 |
$5K |
| D2140 |
|
44 |
26 |
$3K |
| D0603 |
|
278 |
271 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$864.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
32 |
$502.03 |