| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,102 |
2,102 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,844 |
3,843 |
$79K |
| D1120 |
Prophylaxis - child |
2,189 |
2,189 |
$65K |
| D0330 |
Panoramic radiographic image |
1,132 |
1,132 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,553 |
3,553 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,178 |
1,178 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
980 |
900 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,238 |
1,238 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
506 |
505 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
141 |
90 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
931 |
926 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
398 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
130 |
$1K |
| D2140 |
|
20 |
14 |
$1K |