| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
372 |
353 |
$5K |
| D1110 |
Prophylaxis - adult |
165 |
156 |
$4K |
| D0272 |
Bitewings - two radiographic images |
308 |
292 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
44 |
$4K |
| D2160 |
|
48 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
33 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
122 |
116 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
52 |
$931.00 |
| D2140 |
|
27 |
14 |
$907.70 |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
106 |
$812.10 |
| D1120 |
Prophylaxis - child |
27 |
26 |
$784.20 |
| D1206 |
Topical application of fluoride varnish |
85 |
80 |
$678.30 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
40 |
$547.00 |
| D0603 |
|
13 |
12 |
$45.00 |
| D0602 |
|
19 |
16 |
$45.00 |
| D0601 |
|
27 |
27 |
$25.00 |