| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
585 |
527 |
$24K |
| D0272 |
Bitewings - two radiographic images |
854 |
752 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
657 |
576 |
$15K |
| D1120 |
Prophylaxis - child |
347 |
300 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
480 |
391 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
302 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
419 |
382 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
62 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
14 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
15 |
$1K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$759.80 |
| D0240 |
|
20 |
20 |
$456.14 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
13 |
$279.18 |