| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,194 |
1,153 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,821 |
1,785 |
$53K |
| D1120 |
Prophylaxis - child |
982 |
945 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,446 |
1,400 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
518 |
481 |
$22K |
| D0330 |
Panoramic radiographic image |
235 |
219 |
$16K |
| D0274 |
Bitewings - four radiographic images |
297 |
283 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
288 |
225 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
54 |
$7K |
| D0272 |
Bitewings - two radiographic images |
135 |
131 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
76 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
51 |
$971.05 |
| D1999 |
|
18 |
17 |
$0.00 |