| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,648 |
1,427 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,750 |
2,319 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,912 |
2,480 |
$57K |
| D1120 |
Prophylaxis - child |
1,118 |
932 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,512 |
1,350 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
377 |
312 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
393 |
$8K |
| D0601 |
|
945 |
831 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
121 |
$4K |
| D9920 |
|
208 |
197 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
231 |
$3K |
| D0602 |
|
490 |
421 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
12 |
$2K |
| D0240 |
|
13 |
12 |
$286.40 |