| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,613 |
2,613 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,366 |
3,366 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,623 |
2,623 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,752 |
3,752 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
498 |
279 |
$39K |
| D1120 |
Prophylaxis - child |
961 |
961 |
$32K |
| D0330 |
Panoramic radiographic image |
520 |
520 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,493 |
1,487 |
$19K |
| D0272 |
Bitewings - two radiographic images |
703 |
703 |
$13K |
| D2160 |
|
102 |
57 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
180 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
117 |
117 |
$5K |
| D1351 |
Sealant - per tooth |
135 |
38 |
$4K |