| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
206 |
190 |
$5K |
| D0272 |
Bitewings - two radiographic images |
172 |
157 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
198 |
185 |
$4K |
| D0240 |
|
63 |
63 |
$3K |
| D1120 |
Prophylaxis - child |
71 |
71 |
$2K |
| D1110 |
Prophylaxis - adult |
52 |
51 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
15 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$923.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$312.17 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$288.80 |