| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
845 |
812 |
$22K |
| D0272 |
Bitewings - two radiographic images |
725 |
699 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
794 |
768 |
$16K |
| D1110 |
Prophylaxis - adult |
315 |
304 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
879 |
836 |
$15K |
| D1120 |
Prophylaxis - child |
411 |
396 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
844 |
761 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
51 |
$1K |
| D0601 |
|
241 |
229 |
$1K |
| D0602 |
|
179 |
166 |
$895.00 |
| D0603 |
|
123 |
118 |
$615.00 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$478.80 |