| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
898 |
840 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
792 |
740 |
$16K |
| D1120 |
Prophylaxis - child |
584 |
543 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
300 |
272 |
$12K |
| D1110 |
Prophylaxis - adult |
201 |
184 |
$7K |
| D0603 |
|
383 |
344 |
$4K |
| D0272 |
Bitewings - two radiographic images |
205 |
188 |
$4K |
| D1330 |
|
537 |
485 |
$3K |
| D9920 |
|
30 |
30 |
$2K |
| D1310 |
|
121 |
121 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$954.80 |
| D2140 |
|
16 |
12 |
$726.63 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$382.71 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$140.24 |
| D1999 |
|
14 |
14 |
$0.07 |