| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
515 |
444 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
126 |
62 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
453 |
391 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
306 |
218 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
315 |
$6K |
| D0272 |
Bitewings - two radiographic images |
251 |
224 |
$6K |
| D1110 |
Prophylaxis - adult |
139 |
121 |
$6K |
| D1120 |
Prophylaxis - child |
129 |
105 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
273 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
38 |
$4K |
| D2140 |
|
48 |
24 |
$3K |
| D0603 |
|
245 |
210 |
$1K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$279.30 |