| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
653 |
553 |
$17K |
| D1110 |
Prophylaxis - adult |
309 |
249 |
$14K |
| D0272 |
Bitewings - two radiographic images |
570 |
478 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
53 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
235 |
173 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
301 |
243 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
241 |
$6K |
| D2140 |
|
58 |
25 |
$4K |
| D1120 |
Prophylaxis - child |
61 |
56 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$879.20 |