| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
882 |
811 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
764 |
701 |
$16K |
| D1120 |
Prophylaxis - child |
590 |
535 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
235 |
216 |
$9K |
| D1110 |
Prophylaxis - adult |
224 |
210 |
$8K |
| D0272 |
Bitewings - two radiographic images |
257 |
228 |
$4K |
| D0603 |
|
427 |
372 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
56 |
40 |
$3K |
| D1330 |
|
564 |
498 |
$3K |
| D9920 |
|
14 |
14 |
$856.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
32 |
$694.31 |
| D2140 |
|
15 |
12 |
$688.40 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$683.17 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$127.76 |