| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,668 |
1,654 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,520 |
2,493 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,098 |
2,076 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,355 |
2,326 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
525 |
360 |
$39K |
| D1120 |
Prophylaxis - child |
818 |
809 |
$28K |
| D2140 |
|
442 |
334 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
860 |
792 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
132 |
$9K |
| D1351 |
Sealant - per tooth |
55 |
17 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$488.75 |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$313.50 |
| D1999 |
|
28 |
26 |
$0.00 |