| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,669 |
1,617 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,439 |
2,381 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,461 |
1,431 |
$21K |
| D1120 |
Prophylaxis - child |
759 |
749 |
$21K |
| D1206 |
Topical application of fluoride varnish |
833 |
813 |
$16K |
| D0274 |
Bitewings - four radiographic images |
639 |
621 |
$15K |
| D0330 |
Panoramic radiographic image |
181 |
181 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
107 |
82 |
$6K |
| D0272 |
Bitewings - two radiographic images |
281 |
278 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
159 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
133 |
$3K |
| D2140 |
|
16 |
12 |
$691.00 |