| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
486 |
364 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
782 |
598 |
$20K |
| D0272 |
Bitewings - two radiographic images |
610 |
470 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
163 |
59 |
$12K |
| D1206 |
Topical application of fluoride varnish |
580 |
454 |
$11K |
| D2140 |
|
148 |
43 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
244 |
140 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
101 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
98 |
$3K |
| D1120 |
Prophylaxis - child |
32 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
38 |
$794.81 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
13 |
$558.70 |
| D0602 |
|
65 |
43 |
$313.03 |
| D0603 |
|
46 |
28 |
$225.08 |