| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
373 |
218 |
$30K |
| D1110 |
Prophylaxis - adult |
483 |
482 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
827 |
824 |
$22K |
| D0272 |
Bitewings - two radiographic images |
743 |
740 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
721 |
718 |
$14K |
| D2140 |
|
215 |
145 |
$14K |
| D1120 |
Prophylaxis - child |
339 |
337 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
321 |
307 |
$8K |
| D0603 |
|
521 |
520 |
$3K |
| D2160 |
|
17 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
55 |
$1K |