| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
270 |
241 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
365 |
331 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
58 |
$7K |
| D0272 |
Bitewings - two radiographic images |
134 |
131 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
82 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
110 |
$3K |
| D1206 |
Topical application of fluoride varnish |
146 |
145 |
$3K |
| D0274 |
Bitewings - four radiographic images |
55 |
54 |
$1K |
| D2140 |
|
17 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
52 |
$954.40 |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
32 |
$613.19 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$432.90 |