| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
333 |
323 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
465 |
417 |
$12K |
| D1206 |
Topical application of fluoride varnish |
347 |
339 |
$6K |
| D0272 |
Bitewings - two radiographic images |
260 |
254 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
329 |
313 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
197 |
193 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
261 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
27 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
85 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
16 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D0602 |
|
57 |
43 |
$90.00 |
| D0601 |
|
39 |
29 |
$60.00 |
| D0603 |
|
17 |
12 |
$30.00 |