| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,009 |
1,897 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,278 |
3,073 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,860 |
2,725 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,386 |
2,253 |
$52K |
| D1120 |
Prophylaxis - child |
1,231 |
1,159 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
187 |
109 |
$12K |
| D1351 |
Sealant - per tooth |
396 |
68 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
109 |
$9K |
| D0330 |
Panoramic radiographic image |
261 |
249 |
$8K |
| D0274 |
Bitewings - four radiographic images |
227 |
225 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
233 |
216 |
$4K |
| D2140 |
|
32 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
79 |
69 |
$1K |
| D1206 |
Topical application of fluoride varnish |
35 |
27 |
$668.30 |
| D0601 |
|
137 |
133 |
$635.04 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$478.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$319.20 |