| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,293 |
5,205 |
$117K |
| D1110 |
Prophylaxis - adult |
3,037 |
2,989 |
$112K |
| D1206 |
Topical application of fluoride varnish |
4,749 |
4,675 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
985 |
580 |
$45K |
| D1120 |
Prophylaxis - child |
1,684 |
1,667 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,081 |
1,075 |
$27K |
| D0272 |
Bitewings - two radiographic images |
180 |
180 |
$3K |
| D2140 |
|
96 |
71 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
210 |
206 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$971.96 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
24 |
$0.00 |