| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,475 |
1,032 |
$38K |
| D1110 |
Prophylaxis - adult |
747 |
516 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,143 |
801 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
329 |
157 |
$26K |
| D1120 |
Prophylaxis - child |
584 |
405 |
$21K |
| D1206 |
Topical application of fluoride varnish |
886 |
694 |
$17K |
| D2140 |
|
203 |
87 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
478 |
269 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
175 |
128 |
$4K |
| D0603 |
|
489 |
279 |
$2K |
| D0240 |
|
59 |
17 |
$1K |
| D0602 |
|
140 |
72 |
$680.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$614.60 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
19 |
$504.90 |