| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
765 |
735 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,138 |
1,103 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
362 |
211 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,082 |
1,051 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
868 |
842 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
554 |
454 |
$14K |
| D1120 |
Prophylaxis - child |
129 |
128 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$627.00 |
| D0602 |
|
31 |
31 |
$145.00 |