| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,631 |
2,631 |
$131K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,253 |
841 |
$94K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,756 |
2,371 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,677 |
2,677 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,122 |
3,122 |
$71K |
| D1206 |
Topical application of fluoride varnish |
4,321 |
4,321 |
$70K |
| D1120 |
Prophylaxis - child |
1,827 |
1,827 |
$63K |
| D2140 |
|
907 |
641 |
$52K |
| D0330 |
Panoramic radiographic image |
711 |
711 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,441 |
1,441 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
480 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,233 |
1,194 |
$16K |
| D7220 |
|
39 |
15 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
123 |
$5K |
| D2160 |
|
16 |
15 |
$1K |
| D7111 |
|
20 |
13 |
$1K |
| D2940 |
|
27 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$155.85 |