| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,475 |
1,461 |
$101K |
| D1120 |
Prophylaxis - child |
1,412 |
1,394 |
$30K |
| D0272 |
Bitewings - two radiographic images |
995 |
985 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,411 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
66 |
66 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
13 |
$927.95 |
| D0274 |
Bitewings - four radiographic images |
29 |
28 |
$428.50 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |