| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
368 |
354 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
584 |
564 |
$5K |
| D0272 |
Bitewings - two radiographic images |
515 |
494 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
378 |
$2K |
| D1120 |
Prophylaxis - child |
185 |
179 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
93 |
$762.35 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$580.68 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$213.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$162.28 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
45 |
$61.90 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$53.00 |
| D1351 |
Sealant - per tooth |
103 |
24 |
$29.35 |
| D2140 |
|
19 |
13 |
$0.00 |