| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,381 |
1,298 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
1,924 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,193 |
2,011 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,731 |
1,598 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,880 |
1,710 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,806 |
1,639 |
$24K |
| D1120 |
Prophylaxis - child |
252 |
235 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
73 |
$6K |
| D1351 |
Sealant - per tooth |
145 |
26 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
51 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
12 |
$2K |
| D9920 |
|
79 |
76 |
$2K |
| D0601 |
|
300 |
292 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
24 |
$188.10 |
| D0602 |
|
24 |
24 |
$110.32 |