| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,810 |
1,810 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
1,971 |
1,970 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,418 |
1,418 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
407 |
400 |
$10K |
| D1206 |
Topical application of fluoride varnish |
250 |
249 |
$8K |
| D0603 |
|
667 |
667 |
$7K |
| D0272 |
Bitewings - two radiographic images |
558 |
558 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
763 |
761 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
38 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
385 |
$2K |
| D0274 |
Bitewings - four radiographic images |
100 |
99 |
$1K |
| D0602 |
|
30 |
30 |
$300.00 |