| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,074 |
1,051 |
$27K |
| D1110 |
Prophylaxis - adult |
500 |
484 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,015 |
993 |
$20K |
| D0272 |
Bitewings - two radiographic images |
877 |
863 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
40 |
$4K |
| D1120 |
Prophylaxis - child |
105 |
103 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D0601 |
|
190 |
186 |
$780.34 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
24 |
$679.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$458.80 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
12 |
$252.70 |