| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,823 |
1,821 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,431 |
2,428 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,535 |
2,532 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,231 |
1,228 |
$35K |
| D1120 |
Prophylaxis - child |
891 |
891 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,617 |
1,607 |
$23K |
| D0330 |
Panoramic radiographic image |
402 |
400 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,884 |
952 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
137 |
79 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
45 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
166 |
$5K |
| D2140 |
|
35 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$1K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$660.54 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
26 |
$644.13 |