| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,502 |
3,478 |
$126K |
| D1110 |
Prophylaxis - adult |
1,691 |
1,676 |
$122K |
| D1120 |
Prophylaxis - child |
1,437 |
1,432 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,519 |
2,510 |
$60K |
| D0274 |
Bitewings - four radiographic images |
845 |
837 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
71 |
$10K |
| D0272 |
Bitewings - two radiographic images |
318 |
315 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
45 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
33 |
$6K |
| D0330 |
Panoramic radiographic image |
67 |
66 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
44 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
85 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$220.68 |
| D9985 |
|
740 |
714 |
$0.00 |
| D1999 |
|
187 |
171 |
$0.00 |