| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,606 |
1,555 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,938 |
1,876 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,880 |
1,828 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,900 |
1,843 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,141 |
2,052 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,808 |
1,685 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
207 |
130 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
293 |
274 |
$7K |
| D1120 |
Prophylaxis - child |
185 |
182 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$4K |
| D2140 |
|
60 |
46 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$913.40 |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$558.72 |
| D0330 |
Panoramic radiographic image |
17 |
15 |
$125.40 |