| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
961 |
906 |
$24K |
| D1110 |
Prophylaxis - adult |
421 |
410 |
$20K |
| D0272 |
Bitewings - two radiographic images |
691 |
671 |
$17K |
| D1206 |
Topical application of fluoride varnish |
874 |
818 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
817 |
780 |
$15K |
| D1120 |
Prophylaxis - child |
341 |
328 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
714 |
697 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
385 |
285 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
39 |
29 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
65 |
$2K |
| D0602 |
|
194 |
188 |
$965.44 |
| D0603 |
|
100 |
96 |
$500.00 |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
18 |
$432.25 |
| D0601 |
|
53 |
51 |
$265.00 |