| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,347 |
3,017 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
4,367 |
3,948 |
$82K |
| D1110 |
Prophylaxis - adult |
1,520 |
1,343 |
$68K |
| D0272 |
Bitewings - two radiographic images |
4,511 |
4,057 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,034 |
2,717 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
434 |
259 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,593 |
1,473 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,773 |
1,551 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
393 |
354 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,170 |
677 |
$8K |
| D0330 |
Panoramic radiographic image |
106 |
103 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
144 |
$5K |
| D9986 |
|
97 |
85 |
$0.00 |