| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
645 |
558 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
715 |
707 |
$18K |
| D1110 |
Prophylaxis - adult |
320 |
313 |
$15K |
| D0272 |
Bitewings - two radiographic images |
515 |
506 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
799 |
769 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
49 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
576 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
649 |
571 |
$6K |
| D2140 |
|
87 |
54 |
$6K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$521.07 |