| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,612 |
3,610 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
3,781 |
3,778 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,922 |
2,911 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,317 |
1,180 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,087 |
1,087 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,051 |
2,050 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,748 |
1,740 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
79 |
$8K |
| D1110 |
Prophylaxis - adult |
154 |
154 |
$7K |
| D0602 |
|
630 |
622 |
$6K |
| D0603 |
|
618 |
609 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,084 |
1,080 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
113 |
$3K |
| D0601 |
|
293 |
291 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$144.00 |