| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,306 |
1,262 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,291 |
1,263 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,722 |
1,686 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,199 |
1,171 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,393 |
1,302 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
821 |
$21K |
| D1120 |
Prophylaxis - child |
560 |
553 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,165 |
1,056 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
204 |
86 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
29 |
$5K |
| D0603 |
|
1,039 |
1,019 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
89 |
$3K |
| D2160 |
|
19 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
49 |
$2K |
| D2140 |
|
19 |
13 |
$1K |