| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
847 |
803 |
$18K |
| D1206 |
Topical application of fluoride varnish |
923 |
868 |
$17K |
| D1120 |
Prophylaxis - child |
585 |
556 |
$15K |
| D1110 |
Prophylaxis - adult |
355 |
328 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
198 |
$8K |
| D0603 |
|
456 |
424 |
$5K |
| D0272 |
Bitewings - two radiographic images |
253 |
244 |
$4K |
| D1330 |
|
722 |
675 |
$4K |
| D0274 |
Bitewings - four radiographic images |
106 |
94 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
88 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
13 |
$1K |
| D0601 |
|
95 |
90 |
$935.40 |
| D9920 |
|
16 |
15 |
$650.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$449.17 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$352.68 |
| D0602 |
|
12 |
12 |
$122.00 |
| D1999 |
|
15 |
14 |
$0.10 |