| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
568 |
518 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
938 |
855 |
$25K |
| D1206 |
Topical application of fluoride varnish |
824 |
749 |
$16K |
| D2160 |
|
167 |
71 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
849 |
720 |
$15K |
| D0272 |
Bitewings - two radiographic images |
558 |
517 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
639 |
559 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
98 |
$9K |
| D1120 |
Prophylaxis - child |
235 |
218 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
179 |
$7K |
| D2931 |
|
23 |
13 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
77 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
12 |
$2K |
| D0602 |
|
165 |
156 |
$825.00 |
| D0601 |
|
68 |
59 |
$340.00 |