| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
338 |
318 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
429 |
405 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
401 |
$8K |
| D0272 |
Bitewings - two radiographic images |
287 |
273 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
328 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
306 |
287 |
$4K |
| D2140 |
|
66 |
42 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
30 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
101 |
$3K |
| D1110 |
Prophylaxis - adult |
51 |
47 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
32 |
$1K |
| D0603 |
|
274 |
253 |
$1K |
| D0602 |
|
109 |
107 |
$545.00 |