| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,815 |
1,791 |
$88K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,872 |
1,488 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,232 |
2,201 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,460 |
1,439 |
$30K |
| D0330 |
Panoramic radiographic image |
614 |
595 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,179 |
1,161 |
$25K |
| D1120 |
Prophylaxis - child |
440 |
434 |
$15K |
| D2160 |
|
62 |
38 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
622 |
552 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
142 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
428 |
395 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
25 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$180.00 |