| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,096 |
651 |
$98K |
| D2140 |
|
994 |
575 |
$64K |
| D1110 |
Prophylaxis - adult |
1,217 |
1,203 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,612 |
1,599 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
830 |
752 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,327 |
1,293 |
$21K |
| D1120 |
Prophylaxis - child |
640 |
640 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,043 |
1,040 |
$20K |
| D2160 |
|
94 |
70 |
$9K |
| D0330 |
Panoramic radiographic image |
118 |
118 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
113 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
126 |
$2K |