| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,732 |
1,551 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,950 |
1,824 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,080 |
1,864 |
$42K |
| D1206 |
Topical application of fluoride varnish |
1,786 |
1,706 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
974 |
805 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
158 |
64 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
452 |
363 |
$7K |
| D0330 |
Panoramic radiographic image |
137 |
97 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
41 |
$6K |
| D1120 |
Prophylaxis - child |
144 |
144 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
51 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
214 |
173 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
81 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$2K |
| D0603 |
|
392 |
362 |
$2K |
| D2140 |
|
26 |
14 |
$2K |
| D0602 |
|
65 |
39 |
$319.00 |