| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,278 |
1,278 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
573 |
397 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,088 |
1,059 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,055 |
2,055 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,208 |
1,208 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,341 |
1,341 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
400 |
400 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
98 |
$14K |
| D2140 |
|
166 |
122 |
$10K |
| D1110 |
Prophylaxis - adult |
131 |
131 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
315 |
315 |
$5K |
| D0330 |
Panoramic radiographic image |
100 |
100 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$3K |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
14 |
$2K |