| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
716 |
638 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
887 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
62 |
$21K |
| D2140 |
|
272 |
116 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
809 |
694 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
539 |
396 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
243 |
89 |
$13K |
| D0272 |
Bitewings - two radiographic images |
530 |
449 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
44 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
311 |
242 |
$6K |
| D1120 |
Prophylaxis - child |
57 |
35 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
22 |
15 |
$723.40 |