| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
695 |
679 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
759 |
745 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
802 |
786 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
409 |
349 |
$8K |
| D0272 |
Bitewings - two radiographic images |
371 |
363 |
$6K |
| D0330 |
Panoramic radiographic image |
111 |
109 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
79 |
45 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
29 |
$3K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$910.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$616.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$121.00 |