| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,237 |
2,210 |
$41K |
| D1110 |
Prophylaxis - adult |
1,035 |
1,015 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,349 |
2,316 |
$34K |
| D1120 |
Prophylaxis - child |
1,131 |
1,119 |
$31K |
| D0330 |
Panoramic radiographic image |
408 |
397 |
$18K |
| D0274 |
Bitewings - four radiographic images |
719 |
704 |
$16K |
| D0272 |
Bitewings - two radiographic images |
637 |
632 |
$11K |
| D1999 |
|
464 |
428 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
106 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
65 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
12 |
$1K |