| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,547 |
1,519 |
$62K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
432 |
219 |
$51K |
| D1110 |
Prophylaxis - adult |
647 |
636 |
$49K |
| D1120 |
Prophylaxis - child |
486 |
479 |
$27K |
| D0274 |
Bitewings - four radiographic images |
350 |
345 |
$18K |
| D1206 |
Topical application of fluoride varnish |
234 |
230 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
236 |
201 |
$5K |
| D0330 |
Panoramic radiographic image |
41 |
40 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
67 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
108 |
$2K |
| D9986 |
|
33 |
30 |
$640.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$416.02 |